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Anaphylactic small bowel angioedema, abdominal discomfort and diarrhoea: 3 case reports Two men, aged 55 and 46 years (patients 1 and 2), and a 32-year-old woman (patient 3), developed transient anaphylactic small bowel angioedema following administration of iopromide [Ultravist], iopamidol and iohexol [Omnipaque], respectively; also, following administration of mannitol, patient 1 developed abdominal discomfort and diarrhoea, while patients 2 and 3 developed abdominal discomfort. The patients underwent contrast-enhanced CT scans for upper abdominal pain, multiple colon polyps and a right kidney mass, respectively. Patient 1 received 400mL of oral mannitol solution 30 minutes before the study, and an additional 100mL just before the CT scan. Following a conventional CT scan, he received 90mL of IV iopromide 370 mgI/mL at 3 mL/s. Patient 2 received 1000mL of oral mannitol solution to distend the alimentary duct prior to the CT scan. He underwent the same protocol for administration of iodinated contrast media (CM) as patient 1; however, he received an injection of iopamidol 370 mgI/mL. Patient 3 underwent the same examination protocol as for patient 1; however, she received an injection of iohexol 350 mgI/mL. All three patients developed mild abdominal discomfort, while patient 1 also developed mild diarrhoea. Following the CT scan, their symptoms resolved spontaneously. Contrast-enhanced CT scan in the venous phase revealed circumferential proximal small bowel thickening in all three patients, while nonenhanced CT images revealed normal small bowels. The angioedema quickly resolved. Patient 1 underwent a repeat enhanced CT scan with iopamidol 4 months later, which revealed a normal proximal small bowel. Author comment: "All three patients felt mild abdominal discomfort during scanning . . . Only one patient complained of mild diarrhoea on the day of examination. Such symptoms may be caused by oral administration of iso-osmotic mannitol solution before examination for distending the stomach and small intestine." Our findings "indicate that anaphylactic angioedema of the small bowel induced by iodinated CM was self-limiting and resolved quickly without additional intervention". Hu X-H, et al. Transient small bowel angioedema due to intravenous iodinated contrast media. World Journal of Gastroenterology 18: 999-1002, No. 9, 7 Mar 2012. Available from: URL: http://dx.doi.org/10.3748/wjg.v18.i9.999 803070927 China

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Reactions 26 May 2012 No. 1403