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A Gut Feeling: Isolated Small Bowel Angioedema due to Angiotensin-Converting Enzyme Inhibitor
Mauricio B Pinto1, Marc Vecchio2, Michael A Santos2
1Warren Alpert Medical School of Brown University, Providence, RI.
Rhode Island Medical Journal (2013)
|July 26, 2022
Summary
Angiotensin-converting enzyme (ACE) inhibitor use can rarely cause isolated small intestine angioedema. Discontinuing the ACE inhibitor led to symptom resolution in a patient presenting with abdominal pain and vomiting.
Area of Science:
- Gastroenterology
- Pharmacology
- Internal Medicine
Background:
- Angiotensin-converting enzyme (ACE) inhibitors are widely prescribed for hypertension and heart failure.
- ACE inhibitor-induced angioedema is a known, albeit rare, adverse effect.
- Isolated angioedema of the small intestine is an uncommon presentation.
Observation:
- A 32-year-old woman developed left upper quadrant pain, nausea, vomiting, and diarrhea.
- Symptoms began six months after initiating lisinopril, an ACE inhibitor.
- Radiographic findings were consistent with small bowel angioedema.
Findings:
- The patient's symptoms resolved within 48 hours of discontinuing lisinopril.
- Supportive care was also administered.
- This case highlights a rare gastrointestinal manifestation of ACE inhibitor therapy.
Implications:
- Early recognition and withdrawal of the offending ACE inhibitor are crucial for managing this condition.
- Understanding the pathophysiology of ACE inhibitor-induced angioedema is important for risk mitigation.
- Further research into the specific mechanisms and risk factors for visceral angioedema is warranted.
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