Diagnosis and management of angioedema with abdominal involvement: A gastroenterology perspective

Nzeako, Ugochukwu C.

doi:10.3748/wjg.v16.i39.4913

Cited by 48 publications

(76 citation statements)

References 34 publications

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“…2 Abdominal symptoms associated with intestinal angioedema can be acute in onset or chronic and recurrent. 5 Our patient's history, examination, clinical course and findings support the differential diagnosis of allergic versus hereditary versus idiopathic angioedema. 3 Symptoms of abdominal angioedema attacks often mimic other gastrointestinal diseases such as appendicitis, small bowel obstruction, inflammatory bowel disease, gallbladder disease, or diverticulitis.…”

Section: Discussionsupporting

confidence: 54%

Expanding Your Differential for Abdominal Distention in the Pediatric Patient

Zahra

Wakefield

Head

et al. 2016

Clin Pediatr (Phila)

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An 11-year-old African American female with history of adoption, asthma, and known peanut allergy presented after martial arts class for medical attention with abdominal distension, diffuse colicky abdominal pain, and one episode of nonbloody, nonbilious emesis. She denied abdominal trauma or recent nonsteroidal anti-inflammatory drug (NSAID) use. In the emergency department, an abdominal radiograph showed significant gas throughout the entire gastrointestinal tract without evidence of acute obstruction. Labs including comprehensive metabolic panel, complete blood count, amylase, lipase, and urinalysis were all within normal limits. Given significant distention and exquisite tenderness to palpation, she was admitted for further investigation.On hospital day 1, an attempt was made to place a nasogastric (NG) tube for gastric decompression. Within 3 to 5 minutes of the attempt, the patient was noted to develop lip swelling with complaints of tongue and throat tingling. Physical examination was notable for mild hypotension (92/49), mild tachypnea (RR 22), otherwise hemodynamically stable without evidence of wheezing. She received epinephrine, intravenous (IV) methylprednisolone, ranitidine, and diphenhydramine with some relief of facial angioedema. Later that evening, the patient was scheduled for an abdominal/pelvic computed tomography (CT) scan with contrast to further evaluate abdominal distension. Ten to 15 minutes after receiving the IV iohexol contrast, she developed throat swelling and tightness, wheezing, shortness of breath, and worsening abdominal pain. She required 3 doses of epinephrine, a dose of diphenhydramine, and several albuterol nebulization treatments before stabilization. Given the escalation of her symptoms, the patient was transferred to the pediatric intensive care unit (PICU) for increased care.In the PICU, she was given scheduled methylprednisolone. Over the next 12 hours, the patient experienced improvement in respiratory symptoms and was transferred back to the general pediatrics floor. Because of persistent and unimproved abdominal distension, there was concern for abdominal angioedema. Thus, allergy/ immunology and gastroenterology were consulted.The pediatric allergist suggested labs including tryptase, C3, C4, C1 esterase inhibitor function and level, tissue transglutaminase (TTG) IgA antibody, serum IgA, and serum IgE. Labs were reassuring. Tryptase was normal at 3.6 µg/L, C3 and C4 were not decreased, C1 esterase inhibitor level was normal at 28 mg/dL, and C1 esterase inhibitor function was normal at 101%. TTG IgA antibody and serum IgA were normal (0.5 units/mL and 171 mg/dL respectively). Total serum IgE was elevated at 283.9 IU/mL. Serum specific IgE testing to a variety of foods was notable for elevated IgE levels to wheat, corn, peanut, soybean, and tomato.The pediatric gastroenterologist suggested magnetic resonance enterography in addition to the previously obtained CT. Both imaging modalities showed no evidence of bowel inflammation or edema. Over the course of several days,...

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Section: Discussionsupporting

confidence: 54%

Expanding Your Differential for Abdominal Distention in the Pediatric Patient

Zahra

Wakefield

Head

et al. 2016

Clin Pediatr (Phila)

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“…Therefore, clinicians should be aware and should be keeping in mind this extremely rare EAE component in particular when numerous other more frequent causes of ascites have been excluded. Hereditary or acquired angio-oedema could also be presented with abdominal cell wall thickening or ascites as a consequence of fluid accumulation 6. However, determination of serum C 1q , C 1 -esterase inhibitor and functional C 1q -esterase inhibitor usually distinguishes quite easily hereditary or acquired angio-oedema from EAE especially when C 4 complement component is low as in our case since low complement concentrations are not usually expected in EAE 1…”

Section: Discussionmentioning

confidence: 55%

Ascites in a patient with episodic angio-oedema and eosinophilia: thinking outside the box

et al. 2017

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Episodic angio-oedema with eosinophilia (EAE) or Gleich's syndrome is a rare condition characterised by recurrent episodes of oedema and eosinophilia, accompanied by urticaria, fever and weight gain. The presence of ascites has not been reported so far. We report a 21-year-old Caucasian woman who presented with marked ocular oedema and ascites. Laboratory evaluation revealed marked eosinophilia. During the last 3 months, three episodes of facial and neck oedema were reported, which resolved spontaneously over a period of 3-5 days. The diagnosis of EAE was established after exclusion of secondary causes (infections, allergic reactions, collagen diseases, neoplasms) and clonal disorders associated with marked eosinophilia. Low-dose steroids resulted in eosinophil decrease and complete resolution of symptoms, including ascites. This case highlights that ascites can be a very rare manifestation of EAE particularly if other more frequent causes of ascites have been excluded and the clinical and laboratory findings are supportive of EAE.

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“…Les crises abdominales sont aussi à risque de choc hypovolémique [19,20]. Le tableau peut être brutal et intense, simulant une urgence chirurgicale.…”

Section: Crises Abdominalesunclassified