This is a 16‐year‐old African American male with a history of hereditary angioedema of unknown type, diagnosed at age 12, who presented with abdominal pain. He reported a 1‐week history of intermittent non‐bloody diarrhea with abdominal pain that was consistent with his normal flares of angioedema. However, on the day of presentation, he reported multiple bouts of bilious and nonbloody emesis with increasingly severe and persistent abdominal pain, which was uncommon for him. He had no fevers, weight loss, respiratory distress, or facial swelling. In the past, he has required intubation 3 times for life‐threatening respiratory symptoms associated with his an‐gioedema. Typically he treats himself for any facial swelling or abdominal pain with oral diphenhydramine as needed. His family recently moved, so he has not seen an allergist in the last year. Family history is remarkable for hereditary angioedema in his father and a first cousin. Initial abdominal exam revealed a tender abdomen with mild guarding on palpation with bowel sounds present. Complete blood count, electrolytes, blood urea nitrogen, creatinine, and aminotransferases were all normal. A computed tomography of the abdomen and pelvis revealed a small bowel– small bowel intussusception. By the time general surgery had evaluated the patient, his abdominal pain had significantly improved, and his exam revealed a soft abdomen with mild abdominal tenderness diffusely, normal bowel sounds, and no rebound or guarding. Clinically, it appeared that the intussusception had self‐resolved. After several hours of observation with minimal abdominal pain and no vomiting, the patient was restarted on a regular oral diet. He started eating well and was later discharged home with an allergy follow‐up appointment.
Abdominal pain is a common manifestation in a child with hereditary angioedema. Intussusception as a complication of hereditary angioedema is an unusual presentation with very few cases reported. Treatment varies from observation, as in the above patient, to attempting bowel reduction with an air contrast enema, to surgical reduction of the intussus‐cepted bowel. Surgical intervention would involve giving plasma‐derived C1 inhibitor replacement therapy prior to the procedure.
This case report emphasizes that a significant change in the type of abdominal pain a child with hereditary angioedema experiences warrants further investigation for complications such as intussusception.
R. Patel ‐ none