SHM Converge Scientific Abstract ePoster Gallery-Isolated Jejunal Angioedema With Lisinopril Use

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This case report describes a rare example of isolated jejunal angioedema caused by lisinopril. A 42-year-old African American woman with recent hypertension started lisinopril-hydrochlorothiazide and developed two days of severe cramping mid-epigastric abdominal pain, nausea, and vomiting. Her vital signs and laboratory studies, including CBC, CMP, lipase, and stool tests, were normal. CT imaging of the abdomen and pelvis showed thickened jejunal wall consistent with angioedema. Endoscopy revealed only mild gastritis.<br /><br />After lisinopril was stopped, her symptoms improved, she tolerated diet advancement over the next 1–2 days, and repeat CT demonstrated complete resolution of the jejunal thickening. She was discharged with instructions to avoid ACE inhibitors in the future.<br /><br />The report emphasizes that ACE inhibitor–induced angioedema is uncommon but recognized, occurring in about 0.1–0.5% of patients. While it classically affects the skin and mucous membranes, it can also involve the small bowel, presenting with abdominal pain, nausea, vomiting, and sometimes diarrhea. The presumed mechanism involves increased bradykinin levels. Small-bowel angioedema has been reported before, but isolated jejunal involvement is especially rare.<br /><br />The main clinical message is that ACE inhibitor–associated intestinal angioedema should be considered in patients who present with unexplained abdominal pain after starting lisinopril or another ACE inhibitor. Recognizing the CT findings can prevent misdiagnosis, unnecessary invasive procedures, and delay in treatment.

Asset Subtitle

Daim A. Tabba

Meta Tag

Author List Daim A. Tabba, Rekha Reddy

Category Clinical Vignettes

Concept ACE Inhibitor

Concept Small Bowel Angioedema

Concept Lisinopril

Concept Abdominal Pain

Concept Bowel Wall Thickening

Distinguished Non-Finalist

Presenter Organization California University of Science and Medicine

Presenting Author Daim A. Tabba

Track Adult

Keywords

lisinopril

ACE inhibitor

jejunal angioedema

intestinal angioedema

abdominal pain

bradykinin

CT imaging

small bowel

nausea and vomiting

hypertension

ACE Inhibitor

Small Bowel Angioedema

Lisinopril

Abdominal Pain

Bowel Wall Thickening