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- W1488404820 abstract "Angioedema is an episodic disorder caused by increased capillary permeability that results in extravasation of intravascular fluid and angioedematous swellings. The disorder can affect the face, upper airways, gastrointestinal tract, genital area and limbs. Life-threatening presentations include airways obstruction and hypovolemic shock. In the majority of patients, angioedema is either idiopathic or weakly related to exposure to allergens. The latter can include allergic reactions to foods and adverse responses to drugs such as angiotensin-converting enzyme inhibitors. Hereditary angioedema is associated with abnormalities of complement, usually a deficiency of C1 inhibitor. The symptoms of angioedema of the small bowel include abdominal pain, nausea and vomiting. Pathologically, the small bowel wall becomes thick and edematous. Typical changes on a contrast-enhanced computed tomography (CT) scan include a thick small bowel wall, low attenuation of the edematous submucosa and enhancement of a thickened mucosa and serosa. These changes can be segmental or diffuse and are usually associated with fluid distension of the small bowel. The radiological appearance is similar to that of intestinal vasculitis. Other differential diagnoses include bowel ischemia, intramural bleeding, nephrotic syndrome, infections and inflammatory bowel disease. The images shown below were from two different patients with angioedema. The CT scan in Figure 1 shows striking edema of the small bowel wall, enhancement of the mucosa and serosa and fluid accumulation in the bowel lumen. The patient was a 33-year-old woman who was admitted to hospital with abdominal pain, nausea and vomiting. Serum complement studies revealed normal C1-esterase inhibitor functional activity but low levels of C3 and C4. Two years later, she was diagnosed with systemic lupus erythematosus, a disorder that is commonly associated with complement deficiencies. The CT scan in Figure 2 also shows dilatation and thickening of small bowel loops with clear delineation of layers of the small bowel wall. The patient was a 37-year-old man who was admitted to hospital with abdominal pain and facial edema, particularly around the mouth. The episode of angioedema was unexplained although he was known to have atopic dermatitis. Both patients gradually improved with analgesics and intravenous fluids. Subsequently, they were treated with tranexamic acid and d-chlorpheniramine maleate, although neither drug has been evaluated in randomized trials. Contributed by" @default.
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- W1488404820 date "2008-07-01" @default.
- W1488404820 modified "2023-10-16" @default.
- W1488404820 title "Gastrointestinal: Angioedema of the small bowel" @default.
- W1488404820 doi "https://doi.org/10.1111/j.1440-1746.2008.05491.x" @default.
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