Smoger S H, Sayed M A
Department of Internal Medicine, University of Louisville and Department of Veterans Affairs, KY 40292, USA.
South Med J. 1998 Nov;91(11):1060-3. doi: 10.1097/00007611-199811000-00015.
Although angiotensin-converting enzyme inhibitors (ACEIs) are well-known causes of orofacial angioedema, angioedema from these agents involving the bowel is not often considered. We report a case of simultaneous onset of small bowel and orofacial angioedema due to captopril. A 61-year-old black man with hypertension, coronary artery disease, and congestive heart failure had been treated with captopril for 5 years. He had sudden swelling of the lips, face, and tongue, followed by nausea, emesis, abdominal pain, and diarrhea. Other medications included aspirin, indomethacin, allopurinol, colchicine, and nifedipine. Examination showed swelling of the tongue, buccal mucosa, and neck; he also had midabdominal tenderness but no respiratory distress. Laboratory data were normal. A C1-esterase inhibitor level was normal. An ileus pattern was present on abdominal x-ray film. Angioedema was diagnosed, and all signs and symptoms resolved in 24 hours after captopril was discontinued. Clinicians need to be vigilant for bowel involvement from ACEI angioedema.
尽管血管紧张素转换酶抑制剂（ACEIs）是口面部血管性水肿的常见病因，但由这些药物引起的累及肠道的血管性水肿却不常被考虑。我们报告一例因卡托普利导致小肠和口面部同时发生血管性水肿的病例。一名61岁患有高血压、冠状动脉疾病和充血性心力衰竭的黑人男性，已接受卡托普利治疗5年。他突然出现嘴唇、面部和舌头肿胀，随后出现恶心、呕吐、腹痛和腹泻。其他药物包括阿司匹林、吲哚美辛、别嘌醇、秋水仙碱和硝苯地平。检查发现舌头、颊黏膜和颈部肿胀；他还伴有中腹部压痛，但无呼吸窘迫。实验室检查数据正常。C1酯酶抑制剂水平正常。腹部X线片显示有肠梗阻征象。诊断为血管性水肿，停用卡托普利后24小时内所有症状和体征均消失。临床医生需要警惕ACEI引起的血管性水肿累及肠道的情况。
