[Angioneurotic Edema as a Differential Diagnosis of Recurrent Abdominal Pain]

History and admission findings A 46-year-old woman was admitted because of recurrent postprandial vomiting including weight loss of 30 kg within the last 5 - 6 months. The physical investigation was indicative of preileus. Investigations CT scan revealed an unclear thickening of the jejunum. Treatment and course Explorative laparotomy was performed because of the considerable degree of suffering and a tendency of worsening. Intraoperatively, the preoperatively observed thickening was confirmed at 3 subsequent segments of the jejunum (3 cm long each) prompting to segmental resection of the jejunum. The postoperative course was uneventful. Histopathology revealed submucous, partially transmural, segmental edema compatible with an angioneurotic edema. Amyloidosis, sprue and malignancy could be excluded. A C1 esterase inhibitor test war normal. A further search for possible causes revealed ACE inhibitor medication for hypertension. Conclusion The differential diagnostic assessment of isolated small intestine diseases must take into account rare systemic disease. The knowledge of the history of medicine can be useful to detect the - not mandatory - connection to angioedema.