title: Infective endocarditis presenting initially with ileus complicated by dehiscence of annuloplasty ring.
abstract: BACKGROUND
  Infective endocarditis (IE) on an annuloplasty ring dehiscence is uncommon after mitral valve repair.
  
  
  METHODS
  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.
authors.affiliation: Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622, Japan. takaokonishi0915@gmail.com.|Department of Translational Pathology, Hokkaido University, Graduate School of Medicine, Sapporo, Japan. takaokonishi0915@gmail.com.
authors.forename: Takao
authors.initials: T
authors.lastname: Konishi
authors.affiliation: Department of Translational Pathology, Hokkaido University, Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishihara
authors.affiliation: Department of Cardiovascular Surgery, Self Defence Forces Central Hospital, Tokyo, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Cardiovascular Surgery, Saitama Eastern Cardiovascular Hospital, Saitama, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D004696:Endocarditis / Q000150:complications* / Q000000981:diagnostic imaging; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D045823:Ileus / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects*; D008944:Mitral Valve Insufficiency / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000601:surgery; D011475:Prosthesis Failure; D012086:Reoperation; D013203:Staphylococcal Infections / Q000150:complications* / Q000000981:diagnostic imaging; D014463:Ultrasonography