HEREDITARY ANGIOEDEMA, A RARE CAUSE OF ACUTE ABDOMINAL-PAIN WITH ASCITES

History anal clinical findings: Since the age of 16 years a now 25-yea r-old woman had been known to have C1-inhibitor (C1-INH) deficiency. S he presented herself at the emergency department because of acute seve re lower abdominal cramps. A urinary infection had been treat-ed with antibiotics for the previous 4 days. There was marked pain on pressure over the lower abdomen, but there were no signs of peritonitis and bo wel sound were normal. There had been no nausea or vomiting and the st ools had been normal. Investigations: There was a leukocytosis of 10 2 00/mu l, moderately elevated C-reactive protein (44.8 mg/l), haemoglob in concentration of 17 g/dl and haematocrit of 51%. Radiology revealed oedema of the duodenum and sonography showed free fluid in the abdome n. Treatment and course: After excluding an acute abdomen and in view of the C1-INH deficiency treatment was symptomatic. All symptoms compl etely disappeared after 2 days. Conclusions: Exclusively gastrointesti nal symptoms and ascites are rare in patients with hereditary angioede ma. But knowledge of this manifestation of the disease is important be cause patients are sometimes operated under the false diagnosis of acu te abdomen. In severe cases symptomatic treatment may have to be suppl emented by C1-INH administration. Prevention with attenuated androgens should be started or modified, respectively.