Isolated Intestinal Angioedema in the Emergency Department

• Published in: The Journal of emergency medicine Vol. 50; no. 4; pp. 660 - 662
• Main Authors: Belkhouribchia, Jamal, MD, Backaert, Thomas, MD, Neyrinck, Stefan, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2016
• Subjects: Abdominal Pain - diagnosis; Abdominal Pain - drug therapy; acute abdominal pain; Adult; Angioedemas, Hereditary - diagnosis; Angioedemas, Hereditary - drug therapy; angiotensin-converting enzyme inhibitors; C1-inhibitor; Complement C1 Inactivator Proteins - therapeutic use; Complement C1 Inhibitor Protein; Diagnosis, Differential; Emergency; Emergency Service, Hospital; Female; hereditary angioedema; Humans; intestinal angioedema; C1-inhibitor; hereditary angioedema; angiotensin-converting enzyme inhibitors; acute abdominal pain; intestinal angioedema
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2015.09.049

Abstract Background Angioedema is a condition that can cause cutaneous and mucosal edema of practically any part of the body. Isolated edema of the intestines is a rather rare manifestation, but it can cause important morbidity. Hereditary angioedema as well as certain medications can give rise to intestinal angioedema. We have seen a rise in frequency of intestinal angioedema since the advent of angiotensin-converting enzyme inhibitors. Ultrasound of the abdomen is an inexpensive, safe, and easy tool that can help in the differential diagnosis. Case Report We describe the case of a 25-year-old woman who presented with acute abdominal pain. She was diagnosed with intestinal angioedema due to hereditary angioedema type I. Why Should an Emergency Physician Be Aware of This? Misdiagnosis can lead to administering the wrong treatment or even unnecessary surgical interventions. Intestinal angioedema is best treated with purified C1-inhibitor, icatibant, or ecallantide. Fresh frozen plasma is to be avoided because it carries the risk of worsening the symptoms.