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