Imaging of Drug-induced Complications in the Gastrointestinal System

McGettigan, Melissa; Menias, Christine O.; Gao, Zhen; Mellnick, Vincent M.; Hara, Amy K.

doi:10.1148/rg.2016150132

Cited by 29 publications

(17 citation statements)

References 59 publications

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“…The most common symptoms are abdominal pain (100%), emesis (86%) and diarrhea (50%) (1). The diagnosis is usually considered after the identification of wall thickening of the small bowel, particularly the jejunum (2,3). In the absence of a test to confirm the diagnosis, the reversion of the manifestations following the discontinuation of medication for 48 hours is sufficient to establish the exact diagnosis as well as for the treatment (4).…”

Section: Discussionmentioning

confidence: 99%

Angiotensin-converting enzyme inhibitors-induced angioedema of the small bowel mimicking postoperative complication

Ghezzi

Corleta

2017

Rev Esp Enferm Dig

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Only a few cases of angiotensin-converting enzyme inhibitors (ACEI)-induced angioedema of the small bowel (ASB) have been reported. We present a case of ACEI-induced ASB mimicking postoperative complications. Case reportAn 82-year-old white woman with primary adenocarcinoma of the anal canal underwent an uneventful laparoscopic abdominoperineal resection of the rectum and anal canal (pT2pN0cM0). Recently diagnosed with hypertension and treated with losartan 50 mg for four months. She denied drug or food allergies. Surgical history was positive for appendectomy. Losartan was restarted on postoperative day 4. On day 8, she presented mid-epigastric pain, emesis and diarrhea. She had a benign physical examination, except for tenderness in the epigastric area. The routine laboratory examination was normal. The computed tomography (CT) scan revealed marked thickening (8 mm) of the jejunum with relatively low-density submucosa ( Fig. 1A and B). Because of intractable vomiting and consequently non-acceptance of oral and enteral feeding she required a nasogastric tube for bowel decompression and total parenteral nutrition for seven days. Additional investigations showed negative results (normal C1 esterase inhibitor concentration) and led to the hypothesis of ACEI-induced ASB and discontinuation of losartan. She showed clinical improvement within 72 hours and was discharged on day 15. DiscussionASB is an extremely rare complication of ACEI. Clinical manifestations usually appear within 72 hours after taking the medication, but there are reports of occurrence even ten years later. The most common symptoms are abdominal pain (100%), emesis (86%) and diarrhea (50%) (1). The diagnosis is usually considered after the identification of wall thickening of the small bowel, particularly the jejunum (2,3). In the absence of a test to confirm the diagnosis, the reversion of the manifestations following the discontinuation of medication for 48 hours is sufficient to establish the exact diagnosis as well as for the treatment (4).

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Section: Discussionmentioning

confidence: 99%

Angiotensin-converting enzyme inhibitors-induced angioedema of the small bowel mimicking postoperative complication

Ghezzi

Corleta

2017

Rev Esp Enferm Dig

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“…However, several patients who were initially misdiagnosed with ischemia underwent exploratory laparotomy (26). CT findings of ACE inhibitor-induced angioedema include circumferential wall thickening (most commonly involving the jejunum), mural stratification, straightening of bowel loops, interloop or mesenteric edema, and ascites ( Fig 10) (26,35). The laboratory findings are helpful, as there is usually a normal serum lactate level and a normal or only mildly elevated white blood cell count.…”

Section: Angioedema Of the Small Bowelmentioning

confidence: 99%

CT Findings of Acute Small-Bowel Entities

et al. 2018

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Although a broad spectrum of entities can induce acute pathologic changes in the small bowel, there are relatively few imaging features that are characteristic of a specific diagnosis on the basis of CT findings. Specific clinical information, including time course and onset of disease, patient risk factors, and any recent pharmacologic or radiation therapy, is often instrumental in refining the differential diagnosis. A wide spectrum of disorders is reviewed in this article; however, given the breadth of disorders associated with the small bowel, neoplastic and infectious conditions affecting the small bowel that can manifest acutely are not specifically discussed. Vascular diseases that can affect the small bowel regionally or diffusely, including thromboembolic and hypoperfusion phenomena, as well as a spectrum of vasculitides, are reviewed. Iatrogenic causes of small bowel disorders are discussed, including angiotensin-converting enzyme inhibitor-induced angioedema, and chemotherapy- and radiation therapy-associated patterns of disease. Autoimmune and hereditary conditions that can affect the small bowel, including systemic lupus erythematosus and genetic C1 esterase inhibitor deficiency, respectively, are reviewed. RSNA, 2018.

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“…Drug-induced injury to the colon most frequently presents as colitis [36]. Cancer treatment with chemotherapeutics may lead neutropenic enterocolitis, pseudomembranous colitis, or pneumatosis intestinalis [37,38].…”

Section: Drug-induced Colitismentioning

confidence: 99%