SHM Converge Scientific Abstract ePoster Gallery-Telescoping Bowels Invite a Closer Look

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A 26-year-old otherwise healthy woman presented to the emergency department with abdominal pain, nausea, and vomiting. Her history included years of recurrent unexplained abdominal symptoms, previously labeled as irritable bowel syndrome, along with intermittent lower-extremity swelling. Initial evaluation was largely normal except for a positive SARS-CoV-2 PCR and abdominal imaging showing colo-colonic intussusception. Her symptoms improved spontaneously without intervention, and repeat imaging the next day showed resolution, so she was discharged.<br /><br />She returned within 48 hours with abrupt swelling of both hands developing over 5–10 minutes. Because of the rapid onset, an allergic reaction or vascular problem was considered, but vascular imaging showed patent vessels. Complement testing revealed low C4, low C1 esterase inhibitor, and low C1 inhibitor function, consistent with hereditary angioedema (HAE). Colonoscopy was normal and did not identify a structural cause for the intussusception.<br /><br />The case highlights that HAE can present with gastrointestinal symptoms such as abdominal pain, vomiting, and even intussusception due to bowel wall edema. Intussusception in HAE often resolves with conservative management rather than surgery. The authors also note that SARS-CoV-2 infection may trigger HAE attacks, likely through complement activation and inflammatory pathways.<br /><br />The patient was started on HAE-directed therapy, including subcutaneous C1 inhibitor for prophylaxis and an anti-bradykinin agent for breakthrough attacks, and was doing well on follow-up. This case emphasizes that HAE should be considered in patients with recurrent unexplained swelling or episodic abdominal complaints, and that complement/C1 inhibitor testing can establish the diagnosis.

Asset Subtitle

Nicholas Piazza

Meta Tag

Author List Nicholas Piazza, Rimma Osipov, Robert W. Lampman, Stephen Kovacs

Category Clinical Vignettes

Concept Hereditary Angioedema

Concept C1 Esterase Inhibitor

Concept Angioedema

Concept C1 Inhibitor Replacement

Concept Anti-bradykinin Treatment

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Nicholas Piazza

Track Adult

Keywords

hereditary angioedema

intussusception

abdominal pain

C1 esterase inhibitor

low C4

bradykinin

SARS-CoV-2

bowel wall edema

angioedema

recurrent swelling

Hereditary Angioedema

C1 Esterase Inhibitor

Angioedema

C1 Inhibitor Replacement

Anti-bradykinin Treatment