Angiotensin-converting enzyme inhibitor and visceral angio-oedema

Abdominal pain can be a challenging presenting complaint with a broad differential diagnosis. Medication side-effect must always be considered. Visceral angio-oedema secondary to angiotensin-converting enzyme inhibitor use can cause abdominal pain. The association of angiotensin-converting enzyme inhibitor and visceral angio-oedema is not well recognized partly because the onset of angio-oedema might be delayed for months or years after commencement of an angiotensin-converting enzyme inhibitor. The epidemiology of angio-oedema is now changing in parallel with the increasing use of angiotensin-converting enzyme inhibitors. We present a case of visceral angio-oedema secondary to perindopril. This diagnosis requires a high index of suspicion because if not recognized early patients undergo extensive and expensive negative evaluation.