Infective endocarditis presenting initially with ileus complicated by dehiscence of annuloplasty ring

Takao Konishi, Hiroshi Nishihara, Tadashi Ito, Yoshiaki Tanaka

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Infective endocarditis (IE) on an annuloplasty ring dehiscence is uncommon after mitral valve repair. Case Presentation: A 53-year-old man underwent mitral annuloplasty with a 24-mm ring for posterior mitral valve prolapse. He underwent repeat valve repair for recurrent mitral valve regurgitation 4 years later. He was re-hospitalised complaining of vomiting, nausea, general fatigue and left abdominal pain 2 months later, and presented with low-grade fever, leukocytosis and an elevated blood concentration of C-reactive protein. An abdominal computed tomography scan showed multiple embolisms in the liver, kidney and spleen. Transoesophageal echocardiography revealed mitral annuloplasty ring dehiscence and vegetations consistent with IE. The infected annuloplasty ring and vegetations were surgically excised. Blood cultures grew coagulasenegative staphylococcus aureus, consistent with the excised mitral valve histology. The postoperative course was uneventful, without recurrence of IE. Conclusions: Embolic ileus as initial manifestation of IE is rare and might confuse the diagnosis and delay its management. Gastrointestinal signs and symptoms may be the initial manifestations of systemic embolization from infective endocarditis. Transoesophageal echocardiography effectively identified the presence of vegetations and mitral annuloplasty ring dehiscence.

Original languageEnglish
JournalBMC Cardiovascular Disorders
Volume15
Issue number1
DOIs
Publication statusPublished - 2015 Oct 14
Externally publishedYes

Fingerprint

Ileus
Endocarditis
Mitral Valve Annuloplasty
Transesophageal Echocardiography
Mitral Valve
Mitral Valve Prolapse
Leukocytosis
Mitral Valve Insufficiency
Embolism
C-Reactive Protein
Nausea
Abdominal Pain
Signs and Symptoms
Vomiting
Fatigue
Staphylococcus aureus
Histology
Fever
Spleen
Tomography

Keywords

  • Annuloplasty ring dehiscence
  • Infective endocarditis
  • Infective ileus
  • Mesenteric embolism
  • Systemic embolism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Infective endocarditis presenting initially with ileus complicated by dehiscence of annuloplasty ring. / Konishi, Takao; Nishihara, Hiroshi; Ito, Tadashi; Tanaka, Yoshiaki.

In: BMC Cardiovascular Disorders, Vol. 15, No. 1, 14.10.2015.

Research output: Contribution to journalArticle

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N2 - Background: Infective endocarditis (IE) on an annuloplasty ring dehiscence is uncommon after mitral valve repair. Case Presentation: A 53-year-old man underwent mitral annuloplasty with a 24-mm ring for posterior mitral valve prolapse. He underwent repeat valve repair for recurrent mitral valve regurgitation 4 years later. He was re-hospitalised complaining of vomiting, nausea, general fatigue and left abdominal pain 2 months later, and presented with low-grade fever, leukocytosis and an elevated blood concentration of C-reactive protein. An abdominal computed tomography scan showed multiple embolisms in the liver, kidney and spleen. Transoesophageal echocardiography revealed mitral annuloplasty ring dehiscence and vegetations consistent with IE. The infected annuloplasty ring and vegetations were surgically excised. Blood cultures grew coagulasenegative staphylococcus aureus, consistent with the excised mitral valve histology. The postoperative course was uneventful, without recurrence of IE. Conclusions: Embolic ileus as initial manifestation of IE is rare and might confuse the diagnosis and delay its management. Gastrointestinal signs and symptoms may be the initial manifestations of systemic embolization from infective endocarditis. Transoesophageal echocardiography effectively identified the presence of vegetations and mitral annuloplasty ring dehiscence.

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