Diffuse abdominal pain, repeated vomiting and absolute constipation of 10 days duration. Past history of rheumatic valvular disease and AF. She had a tachycardic pulse with AF. Echo: Moderate MR, severe AS and AR. Erect AXR: Multiple gas-fluid levels suggestive of intestinal obstruction. Abdominal ultrasound: Multiple dilated bowel loops with decreased wall thickness, no peristalsis, with to-and-fro movement of its contents. Mild free fluid. Unfortunately she died two days later.