Small bowel angioedema (ACE-inhibitor related)

Case contributed by Dr Michael P Hartung


Abdominal pain.

Segmental mid small bowel wall thickening with targetoid enhancement and small ascites. 

Midline scar related to recent surgery. Worsening distal small bowel thickening with target-like enhancement. Small ascites. 

Day 75 (follow-up after cessation of medication)


Resolved small bowel inflammation. 

Case Discussion

This patient presented with severe abdominal pain, and had concern of ischemia from the first CT and proceeded to exploratory surgery with negative results. The patient's pain continued for more than a month before repeating the imaging with worsening inflammation, prompting the suggested diagnosis of ACE-inhibitor-related angioedema. After this suggestion, the medication was stopped and the patient's symptoms rapidly improved, with resolution of bowel wall thickening at the final follow-up scan. 

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