Angio-oedeem: een zeldzame oorzaak van koliekpijn

Casuïstiek
07-01-2020
Lisanne E. Visser, Berrie Meijer, Danny M. Cohn en Suzanne M. Linger-Wever

Angioedema; a rare cause of colicky pain

Background

Angioedema is a disease leading to local or generalized swelling of skin or mucosa, due to a higher vascular permeability. Acquired angioedema is a rare disorder which usually manifests after the 4th decade, and is most often secondary to a B-cell disorder.

Case description

A 50-year-old woman without notable medical history was admitted to the emergency department because of severe colicky pain. With a suspected diagnosis of choledocholithiasis, an ultrasound of the abdomen was performed. This did not show any gall stones, though ascites was present. A subsequent CT-scan showed extensive thickening of the bowel wall, suggestive for intestinal angioedema. Based on the clinical characteristics and low activity of C1-esterase inhibitor (C1-INH), combined with the presence of auto-antibodies against C1-INH in the blood, the diagnosis of acquired angioedema was made. Treatment consisted of weakened testosterone, tranexamic acid and rituximab.

Conclusion

Colicky pains, combined with test results indicative of haemoconcentration and absence of cholestasis or inflammation, could be a manifestation of intestinal angioedema.

Conflict of interest and financial support: potential conflicts of interest have been reported for this article. ICMJE forms provided by the authors are available online along with the full text of this article.