title: Unnecessary surgery for acute abdomen secondary to angiotensin-converting enzyme inhibitor use.
abstract: Acute abdominal pain is the reason for 5% to 10% of all emergency department visits. In 1 in every 9 patients, operated on for an acute abdomen, laparotomy is negative. In a minority of patients, the acute abdomen is caused by side effects of medication. We present a case of unnecessary abdominal surgery in a patient with acute abdominal pain caused by intestinal angioedema (AE), which was eventually due to angiotensin-converting enzyme inhibitor (ACE-i) use. We hope that this case report increases awareness of this underdiagnosed side effect. Emergency department physicians, surgeons, internists, and family physicians should always consider ACE-i in the differential diagnosis of unexplained abdominal pain. Since early withdrawal of the medication causing intestinal AE can prevent further complications and, in some cases, needless surgery, we propose an altered version of the known diagnostic algorithm, in which ACE-i and nonsteroidal anti-inflammatory drugs-induced AE is excluded at an early stage.
authors.affiliation: Department of Internal Medicine, Reinier de Graaf Group of Hospitals, 2600GA Delft, The Netherlands. degraaff@erasmusmc.nl
authors.forename: Laura C G
authors.initials: LC
authors.lastname: de Graaff
authors.forename: Martijn
authors.initials: M
authors.lastname: van Essen
authors.forename: Eleonora M
authors.initials: EM
authors.lastname: Schipper
authors.forename: Henk
authors.initials: H
authors.lastname: Boom
authors.forename: Erik J J
authors.initials: EJ
authors.lastname: Duschek
mesh_terms: D000006:Abdomen, Acute / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000601:surgery*; D000799:Angioedema / Q000139:chemically induced / Q000175:diagnosis / Q000000981:diagnostic imaging; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000000981:diagnostic imaging; D017706:Lisinopril / Q000009:adverse effects; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D017706:Lisinopril