IntroductionIntestinal angioedema is a rare adverse effect of angiotensin converting enzyme inhibitors.Clinical caseA 42-year old woman presented to the Emergency Department complaining of diffuse abdominal pain, predominantly in the right quadrants, with no other associated symptoms.She had been started on perindopril plus indapamide 72 h before the admission for arterial hypertension. There was no other relevant background.Physical examination suggested peritoneal irritation on the lower quadrants of the abdomen and right flank.Laboratory tests were relevant for mild leukocytosis. Abdomen ultrasound and contrast-enhanced computed tomography scan showed moderate amount of fluid in the pelvic excavation and small intestine wall thickening. She was admitted for observation. Once the hypothesis of intestinal angioedema was admitted, angiotensin converting enzyme inhibitor was withheld and no other-directed therapy was instituted. Within 24 h she showed clinical, analytic and imaging improvement, thus supporting this diagnosis.ConclusionThe diagnosis of intestinal angioedema induced by angiotensin converting enzyme inhibitor can be challenging and time consuming due to its rarity and nonspecific symptoms, which may lead to underdiagnosis of this entity.

ResumoCom o envelhecimento da população, prevê-se mais idosos no Serviço de Urgência (SU). Neste estudo pretendemos avaliar o tempo de estadia do Idoso num SU Polivalente, a sua triagem e orientação. Realizamos um estudo retrospetivo, e selecionamos uma amostra aleatória simples correspondendo a 14% de todos os doentes admitidos durante um mês num SU Polivalente para adultos, sendo excluída a Urgência Obstétrica, correspondendo a 1252 dos 8872 episódios. Foram recolhidos dados demográficos, triagem de Manchester, especialidades envolvidas na avaliação do doente e a demora no SU. O tratamento estatístico foi elaborado usando SPSS® versão 23, usando os testes de Qui-quadrado e os testes não paramétricos de Mann-Whitney e Kruskal-Wallis. Nesta amostra, 53% dos doentes eram do sexo feminino, com idade mé-dia de 53.9 anos, sendo que 32.4% eram idosos (≥ 65 anos). A mediana da demora no SU foi 215 minutos. As especialidades que observaram o maior número de doentes pela primeira vez foi a Medicina Geral e Familiar (MGF) em 30.2%, seguida da Medicina Interna (25.3%). A mediana do tempo de estadia do idoso no SU foi superior ao grupo não idoso (271 vs 188 minutos) (p<0.001). A atribuição de prioridade de maior severidade foi superior nos idosos (p<0.001). Nos mais jovens, a especialidade mais atribuída pela triagem foi a MGF, nos idosos a especialidade era a Medicina Interna (p<0.001). Os doentes idosos apresentaram maior probabilidade de serem internados (p<0.001). Assim, no doente idoso verificou-se uma maior demora no SU, uma triagem mais prioritária e a necessidade de cuidados mais diferenciados. Palabras clave: Departamento de Emergencias. Geriatria. Duración de la estancia. AbstractAging is a problem affecting Emergency Medicine, requiring prepared staff for special needs of older patients. We intended to understand Colour Manchester Triage and length of stay (LOS) differences to younger patients and further orientation. We conducted a retrospective, observational study, with a randomized sample of 14% of total patients admitted during a month in an Emergency department (1252 in 8872 episodes), excluding children and obstetric patients. We collected demographic data, Manchester triage, medical speciality involved, length of stay and destination. Statistical analysis was performed in SPSS ® 23.0 using qui-square, Mann-Whitney and Kruskal-Wallis tests. In our sample, 53% were female, medium age was 53,9 years old (yo), and 32,4% were 65 yo or older. Median LOS in the Emergency Department (ED) was 215 minutes. Median LOS in geriatric patients were higher than younger population (271 vs 188 minutes) (p<0.001). Priority triage was higher in older patients (p<0.001). Manchester triage attributed most patients to General Practice (30.2%), followed by Internal Medicine (25.3%). However, in geriatric population most patients were observed by Internal Medicine while younger patients were observed by General Practice (p<0.001). Older patients were more frequently admitted into ward than younger patients (p<0.001). Older patie...

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