2. ACE-I Angioedema of the Intestine AM Report 28 May 2009 J. Ryan Altman, MD Charles Van Der Horst, MD

3. AIAI DDx Inflammatory bowel disease Ischemia Vasculitis Infection Mechanical obstruction Lymphoproliferative disorder Acquired or hereditary C1 esterase deficiency

4. AIAI Classical presentation Middle aged female with abdominal pain, emesis, diarrhea, on ACE-I Labs studies Leukocytosis, ascites, edematous bowel on CT

5. AIAI Angioedema of the Intestine K. W.P. Gregory and R. C. Davis - 20 Jun, 1996

6. AIAI 15 case reports 14/15 female 2/15 involved oropharyngeal angioedema Most common sx: pain, emesis, watery diarrhea Common signs: thickening or edematous small bowel on CT, ascites, leukocytosis Most develop sx w/in 24-48h, although 1 pt took 6 mos.

7. AIAI Mechanism of Action Bradykinin associated vasodilation and altered vascular permeability cause the edema Induces tissue specific and anti-nuclear antibodies

8. AIAI Schmidt TD, McGrath KM. Angiotensin-Converting Enzyme Inhibitor Angioedema of the Intestine: A Case Report and Review of the Literature. The American Journal of the Medical Sciences: August 2002;324(2):106-108 Abdelmalek MF, Douglas DD. Lisinopril-Induced Isolated Visceral Angioedema: Review of ACE-Inhibitor-Induced Small Bowel Angioedema. Digestive Diseases and Sciences April 1997;42(4):847-850. Marmery H, Mirvis SE. Angiotensin-converting enzyme inhibitor- induced visceral angioedema. Clinical Radiology 2006,61:979- 982. Chase MP, Fiarman GS et. al. Angioedema of the Small Bowel Due to an Angiotensin-converting Enzyme Inhibitor. J Clin Gastroenterol 2000;31(3):254-257.