…angioedema of what?

A middle-aged African American female presents to your emergency department with two days of diffuse abdominal pain, distention, nausea, emesis and watery diarrhea.  She has a history of asthma and hypertension, for which she was recently started on amlodipine/benazeprilat.  On physical exam she is mildly tachycardic with non-peritoneal mid-epigastric and LLQ abdominal pain. Initial laboratory investigation is unremarkable other than for mild hypokalemia.  An acute abdominal series is ordered demonstrating a non-specific bowel gas pattern.  You suspect a small bowel obstruction, but what might you consider given the patient’s history?  Surgical adhesions?  Diverticulitis? 

A CT of the abdomen and pelvis is ordered demonstrating marked small bowel wall thickening.  The WBC was normal.  Could this be infectious?  Lactate – normal, certainly unlikely ischemic.  What in the patient’s history could point you towards the cause?

Continue reading

Advertisements