Ramipril-Induced Isolated Small Bowel Angioedema: A Case Report

Isolated small bowel angioedema is an uncommon adverse reaction to angiotensin-converting enzyme (ACE) inhibitors, predominantly affecting females. The nonspecific clinical presentation, along with the lack of definitive diagnostic laboratory and radiological findings, makes the diagnosis particularly challenging. We present the case of a 63-year-old female patient who developed diffuse abdominal pain and nausea just seven days after starting ramipril. The diagnosis of ACE inhibitor-induced small bowel angioedema was confirmed by a computed tomography (CT) scan of the abdomen and the pelvis, which revealed circumferential wall thickening and submucosal edema involving multiple jejunal loops. These findings were consistent with angioedema. The condition was successfully managed by discontinuing the medication, and the patient showed rapid clinical improvement within 48 hours of stopping ramipril. To our knowledge, this is only the second reported case of ramipril-induced isolated small bowel angioedema in the literature.