Weingärtner Oliver, Weingärtner Nadja, Böhm Michael, Laufs Ulrich
Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Kirrberger Strasse, Gebäude 40, Homburg/Saar, 66421, Germany.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.09.2008.0868. Epub 2009 Feb 27.
Angiotensin-converting enzyme (ACE) inhibitor treatment was started in a 67-year-old woman with arterial hypertension. Two days later she complained of a hoarse, raspy voice and progressive abdominal pain. The laboratory investigation was within normal limits. However, CT scans of the abdomen revealed marked thickening of the proximal jejunum together with substantial fluid accumulation in the abdomen and pelvis. Due to the severity of the symptoms diagnostic laparatomy was considered as a surgical option. Several hours later the patient started to complain about a progressive inspiratory stridor, which resolved after treatment with epinephrine, antihistamines and corticosteroids. ACE inhibitor induced angioedema was suspected and ACE inhibitor treatment was stopped, after which the severe abdominal symptoms also resolved completely. ACE inhibitor induced angioedema is a rare and often unrecognised side effect of ACE inhibitor treatment that physicians need to be aware of in order to avoid unnecessary invasive procedures, including explorative laparatomy.
一名67岁患有动脉高血压的女性开始接受血管紧张素转换酶（ACE）抑制剂治疗。两天后，她抱怨声音嘶哑、刺耳，并伴有进行性腹痛。实验室检查结果在正常范围内。然而，腹部CT扫描显示空肠近端明显增厚，同时腹部和盆腔有大量积液。由于症状严重，考虑将诊断性剖腹手术作为一种手术选择。几个小时后，患者开始抱怨出现进行性吸气性喘鸣，经肾上腺素、抗组胺药和皮质类固醇治疗后症状缓解。怀疑是ACE抑制剂诱发的血管性水肿，于是停用了ACE抑制剂治疗，之后严重的腹部症状也完全消失。ACE抑制剂诱发的血管性水肿是ACE抑制剂治疗中一种罕见且常未被认识到的副作用，医生需要对此有所了解，以避免不必要的侵入性操作，包括探索性剖腹手术。
