Unresolved Chronic Diarrhea: A Case of Angiotensin-Converting Enzyme Inhibitor-Induced Mesenteric Angioedema

Area of Science:

• Gastroenterology
• Cardiology
• Nephrology

Background:

• Angiotensin-converting enzyme inhibitors (ACEI) are widely used for cardiovascular and renal conditions.
• ACEI-induced visceral angioedema is an uncommon adverse effect that presents diagnostic challenges.
• Symptoms are often non-specific, leading to delayed or missed diagnoses.

Purpose of the Study:

• To highlight the diagnostic challenges of ACEI-induced visceral angioedema.
• To review key CT imaging findings suggestive of this condition.
• To emphasize the importance of considering ACEI-induced angioedema in differential diagnoses.

Main Methods:

• Review of clinical presentation and diagnostic indicators.
• Analysis of CT scan findings, including the 'target' sign, bowel loop elongation, mesenteric edema, and vascular changes.
• Case presentation of a Caucasian male with delayed diagnosis.

Main Results:

• Key CT findings include the 'target' sign, elongated bowel loops, enlarged mesenteric vessels, mesenteric edema, and thickened omentum.
• Absence of vascular compromise or adenopathy on CT is notable.
• Discontinuation of ACEI typically resolves symptoms within 48 hours.

Conclusions:

• ACEI-induced visceral angioedema is infrequent, often overlooked, and diagnostically challenging due to non-specific symptoms.
• While more common in females and African Americans, this condition must be considered in all demographic groups.
• Including ACEI-induced angioedema in the differential diagnosis can prevent unnecessary investigations and procedures.