ACE-I Angioedema of the Intestine

AM Report28 May 2009J. Ryan Altman, MDCharles Van Der Horst, MD

AIAI

DDx Inflammatory bowel disease IschemiaVasculitis InfectionMechanical obstructionLymphoproliferative disorderAcquired or hereditary C1 esterase

deficiency

AIAI

Classical presentationMiddle aged female with abdominal pain,

emesis, diarrhea, on ACE-ILabs studies

Leukocytosis, ascites, edematous bowel on CT

AIAI

Angioedema of the Intestine

K. W.P. Gregory and R. C. Davis - 20 Jun, 1996

AIAI

15 case reports14/15 female2/15 involved oropharyngeal angioedemaMost common sx: pain, emesis, watery

diarrheaCommon signs: thickening or edematous

small bowel on CT, ascites, leukocytosisMost develop sx w/in 24-48h, although 1 pt

took 6 mos.

AIAI

Mechanism of ActionBradykinin associated vasodilation and

altered vascular permeability cause the edema

Induces tissue specific and anti-nuclear antibodies

AIAI

Schmidt TD, McGrath KM. Angiotensin-Converting Enzyme Inhibitor Angioedema of the Intestine: A Case Report and Review of the Literature. The American Journal of the Medical Sciences: August 2002;324(2):106-108

Abdelmalek MF, Douglas DD. Lisinopril-Induced Isolated Visceral Angioedema: Review of ACE-Inhibitor-Induced Small Bowel Angioedema. Digestive Diseases and Sciences April 1997;42(4):847-850.

Marmery H, Mirvis SE. Angiotensin-converting enzyme inhibitor-induced visceral angioedema. Clinical Radiology 2006,61:979-982.

Chase MP, Fiarman GS et. al. Angioedema of the Small Bowel Due to an Angiotensin-converting Enzyme Inhibitor. J Clin Gastroenterol 2000;31(3):254-257.