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Reversible acute abdominal episode of hereditary angioneurotic edema.

A 42-year-old woman presented with nausea, vomiting, and increasing abdominal cramping pain. The abdomen was soft but diffuse tenderness was present. Laboratory tests showed a white blood cell count at 14,300 and C-reactive protein at 0,4 mg. Contrast enhanced abdominal MSCT (A,B) demonstrated ascites in the Douglas pouch, perihepatic (white star) and perisplenic spaces, extensive inflammation of the great omentum in the hypogastric area (white arrows), and segmental thickening of a mesogastric ileal loop (black arrow) with edema of the corresponding mesenteric segment (black arrow head). Clinical and radiological findings were suggestive of an acute but equivocal abdominal condition such as peritoneal carcinomatosis or small bowel ischemia. Surgical laparotomy was considered. Fortunately, the patient had recently experienced two episodes of Quincke’s edema – one accompanied by laryngeal edema – that had been investigated and finally attributed to hereditary angioneurotic edema due to a sharp deficit in C1 esterase inhibitor and in C4 complement factor. Under analgesic and corticosteroid drugs, clinical evolution was rapidly favourable and a control CT obtained four days later showed complete healing.