title: [Angioneurotic Edema as a Differential Diagnosis of Recurrent Abdominal Pain].
abstract: History and admission findingsA 46-year-old woman was admitted because of recurrent postprandial vomiting including weight loss of 30 kg within the last 5 - 6 months. The physical investigation was indicative of preileus.InvestigationsCT scan revealed an unclear thickening of the jejunum.Treatment and courseExplorative laparotomy was performed because of the considerable degree of suffering and a tendency of worsening. Intraoperatively, the preoperatively observed thickening was confirmed at 3 subsequent segments of the jejunum (3 cm long each) prompting to segmental resection of the jejunum. The postoperative course was uneventful. Histopathology revealed submucous, partially transmural, segmental edema compatible with an angioneurotic edema. Amyloidosis, sprue and malignancy could be excluded. A C1 esterase inhibitor test war normal. A further search for possible causes revealed ACE inhibitor medication for hypertension.ConclusionThe differential diagnostic assessment of isolated small intestine diseases must take into account rare systemic disease. The knowledge of the history of medicine can be useful to detect the - not mandatory - connection to angioedema.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R.
authors.forename: Claudia
authors.initials: C
authors.lastname: Schadow
authors.affiliation: Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R.
authors.forename: Cora
authors.initials: C
authors.lastname: Wex
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R.
authors.forename: Christian
authors.initials: C
authors.lastname: Wybranski
authors.affiliation: Institut für Pathologie, Universitätsklinikum Magdeburg A.ö.R.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kalinski
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg A.ö.R.
authors.forename: Christian
authors.initials: C
authors.lastname: Schulz
authors.affiliation: Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R.
authors.forename: Frank
authors.initials: F
authors.lastname: Meyer
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced* / Q000175:diagnosis*; D000799:Angioedema / Q000139:chemically induced* / Q000175:diagnosis*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007579:Jejunal Diseases / Q000139:chemically induced* / Q000175:diagnosis; D008875:Middle Aged; D012008:Recurrence
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors