Endocarditis following an unsuccessful attempt to remove a gastric GI stromal tumor by laparoscopic endoscopic cooperative surgery

Gastrointestinal Stromal Tumors (GIST) are the most common subepithelial lesions of the gastrointestinal tract. Treatment of lesions greater than 2 cm in diameter is by laparoscopic wedge resection. We report a 77-year-old man who was diagnosed with a 2.3 cm diameter gastric GIST. He had a thickened mitral valve, severe mitral annular calcification, mild mitral regurgitation and moderate aortic stenosis. One week after undergoing an unsuccessful attempt at Laparoscopic Endoscopic Cooperative Surgery (LECS), he was admitted with a fever of 40.2o C. Blood cultures grew Staphylococcus lugdunensis. Transthoracic and transesophageal echocardiography revealed moderate mitral regurgitation and an 8 X 5 mm vegetation on the mitral valve and posterior annulus. This is the first report of endocarditis following LECS. Physicians need to be aware of this possible complication.