Angioedema of the small bowel caused by lisinopril

Description 

A 42-year-old man with a history of chronic kidney disease (stage III) and hypertension presented to an outside hospital with acute onset of left lower quadrant abdominal pain that woke him from his sleep. He described the pain as 8/10 in severity, cramping in nature and worsened by eating or drinking. Pain was associated with nausea, intractable vomiting, dyspnoea and dizziness. Ten-point review of systems was negative except for the above reported symptoms.

Vitals on admission were stable. He had tenderness over the suprapubic and left lower quadrant. Physical exam was otherwise unremarkable. His white cell count was elevated at 14.6x10³ per microlitre, haemoglobin was 17.0 g/dL, lactate was 1.9 mg/dL and lipase and stool studies were negative. Initial CT of the abdomen pelvis (figure 1) with contrast showed thick-walled small bowel loops of the proximal ileum and jejunum with surrounding haziness producing luminal narrowing. There was...

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