lisinopril and Abdominal-Pain

Abdominal wall pain (AWP) is a common and underrecognized cause of chronic abdominal pain. The etiology of AWP varies. History and physical examination are critical to an accurate diagnosis of AWP. Trigger point injection using either a corticosteroid, a local anesthetic, or a combination of both often gives relief of pain and is of diagnostic and therapeutic value. Increased awareness of AWP as a cause of chronic, nonvisceral abdominal pain can prevent fruitless searches for intra-abdominal pathology and reduce medical costs.

Topics: Abdominal Pain; Abdominal Wall; Aged; Angiotensin-Converting Enzyme Inhibitors; Calcium Gluconate; Diagnosis, Differential; Diuretics; Furosemide; Humans; Hyperkalemia; Infusions, Intravenous; Lisinopril; Male; Potassium; Renal Insufficiency, Chronic

Topics: Abdominal Pain; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Ascites; Duodenal Diseases; Female; Humans; Intestinal Diseases; Jejunal Diseases; Lisinopril; Middle Aged; Proteinuria; Tomography, X-Ray Computed

BACKGROUND Angiotensin-converting enzyme inhibitors (ACE-I) are one of the most frequently prescribed classes of medications with the rare adverse effect of angioedema, and isolated small bowel angioedema is a small subset of these cases. Isolated angioedema of the small bowel is a rare adverse effect of this commonly prescribed medication, and it mimics, symptomatically and radiographically, several other illnesses and is often misdiagnosed. While ACE-I are thought to be safe, the risk of angioedema is approximately 0.7%. Isolated small bowel angioedema is often not diagnosed in a timely manner, and misdiagnosis leads to significant morbidity in afflicted patients. CASE REPORT We present the case of a 63-year-old woman with angioedema of the small bowel causing abdominal pain, nausea, vomiting, and diarrhea. Computed tomography demonstrated small bowel edema and ascites. The patient had been taking lisinopril for 7 years prior to presentation and had previously been seen by multiple physicians for abdominal pain. A diagnosis of ACE-I-induced small bowel angioedema was made and lisinopril therapy was immediately stopped. Her symptoms improved with cessation of lisinopril, and follow-up imaging showed resolution of the angioedema 3 months later. CONCLUSIONS The course of ACE-I-induced angioedema is unpredictable and often overlooked as a cause of abdominal pain. It commonly presents soon after starting ACE-I therapy, but can present years after therapy initiation, as in this case. Significant morbidity, including unnecessary exploratory laparotomy, is associated with misdiagnosis of ACE-I-induced angioedema of the small bowel. Prompt recognition and cessation of the offending drug is crucial but often delayed.

Topics: Abdomen; Abdominal Pain; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Female; Humans; Lisinopril; Middle Aged

ACE inhibitors (ACEi) are common anti-hypertensive drugs that can cause angioedema. Though classic, or facial angioedema is rare, visceral angioedema is even less common. When angioedema occurs, it typically presents early, within 30 days of initiating therapy. Visceral angioedema most commonly presents with nausea, emesis, abdominal pain and diarrhoea, and thus is often mistaken for an episode of gastroenteritis. When a CT scan is obtained, it typically shows characteristic findings, including ascetic fluid, mild mesenteric oedema and thickening of the small bowel. In this case report, we present a patient who did not experience her first episode of visceral angioedema until after she had been on ACEi therapy for 5-7 years. In addition, she experienced recurrent episodes of visceral angioedema that were separated by approximately 4 years at a time. Both of these features make for a particularly unique presentation.

Topics: Abdominal Pain; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Anti-Allergic Agents; Diagnosis, Differential; Diarrhea; Female; Glucocorticoids; Histamine H2 Antagonists; Humans; Lisinopril; Middle Aged; Nausea; Tomography, X-Ray Computed; Treatment Outcome; Viscera

In conjunction with

Topics: Abdominal Pain; Adult; Angioedema; Antihypertensive Agents; Diagnosis, Differential; Humans; Hypertension; Ileal Diseases; Lisinopril; Male; Renal Insufficiency, Chronic; Tomography, X-Ray Computed

Topics: Abdominal Pain; Adult; Angioedema; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Diagnosis, Differential; Female; Humans; Lisinopril; Losartan

ACE inhibitors are the leading cause of drug-induced angio-oedema in the USA. ACE inhibitor-induced intestinal angio-oedema, a much rarer complication of this medication, has been reported. The author reports a patient presenting with a 1-day history of severe abdominal pain. The patient was started on lisinopril 2 days prior to this presentation. Computer axial tomography (CAT) scan of the abdomen demonstrated extensive and marked thickening, and oedema involving the duodenum and proximal jejunum associated with significant mesenteric oedema. Concerns for visceral angio-oedema and a possible association with lisinopril according to the Naranjo algorithm were raised. Lisinopril was discontinued and the patient was treated with antihistamines. The patient improved clinically in the next 24 h and discharged home with education and documentation of this serious allergy. ACE inhibitor-induced visceral angio-oedema is under-reported and most often missed resulting in waste of hospital resources towards working up this clinical diagnosis.

Topics: Abdominal Pain; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Diagnosis, Differential; Duodenal Diseases; Female; Humans; Jejunal Diseases; Lisinopril; Middle Aged; Tomography, X-Ray Computed

Topics: Abdomen; Abdominal Pain; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Female; Humans; Hypertension; Lisinopril; Middle Aged; Tomography, X-Ray Computed; Ultrasonography; Withholding Treatment

To report a case of possible lisinopril-induced angioedema of the small bowel.. A 67-year-old female was admitted to the hospital with abdominal pain, nausea, vomiting, and diarrhea. A computed tomography (CT) scan of the abdomen/pelvis was obtained which showed wall thickening around the area of the jejunum and scant ascites consistent with several diagnoses, including small bowel angioedema. She was treated with intravenous fluids and nasogastric decompression. Stool studies were negative. Her lisinopril was held due to the possibility of small bowel angioedema. A CT enterography obtained 5 days after the discontinuation of lisinopril showed complete resolution of the inflammatory changes and perihepatic fluid. It was felt that angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema of the small bowel was the most likely etiology of her symptoms.. Angiotensin-converting enzyme inhibitor small bowel angioedema is an uncommon cause of abdominal symptoms. In several cases, patients had been taking ACEIs for years before symptoms occur. Treatment includes cessation of the ACEI and supportive care.. Angiotensin-converting enzyme inhibitor-related small bowel angioedema should be considered in the differential diagnosis of unexplained abdominal pain.

Topics: Abdominal Pain; Aged; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Diagnosis, Differential; Diarrhea; Female; Humans; Intestinal Diseases; Intestine, Small; Lisinopril; Nausea; Time Factors; Tomography, X-Ray Computed; Vomiting

Topics: Abdominal Pain; Adult; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Biopsy; Female; Humans; Hypertension; Ileal Diseases; Ileum; Lisinopril; Magnetic Resonance Imaging; Nausea; Recurrence; Vomiting

Angiotensin-converting enzyme (ACE) inhibitors are known to cause potentially fatal peripheral angioedema in some patients. ACE inhibitors may also cause isolated visceral angioedema, a rarely reported complication. This article describes 2 patients who experienced this complication. Both patients came to medical attention with episodes of recurrent abdominal symptoms that had occurred while taking ACE inhibitors for hypertension. Each patient had undergone surgical procedures for symptoms that persisted after surgery and were ultimately relieved with cessation of their ACE inhibitors. These cases call attention to what may be an underappreciated cause of abdominal pain in patients presenting to emergency departments.

Topics: Abdominal Pain; Adult; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Female; Fosinopril; Humans; Lisinopril; Male; Tomography, X-Ray Computed

Topics: Abdominal Pain; Adult; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Female; Humans; Lisinopril