Recurrent ascites: a need to evaluate for hereditary angio-oedema

Review of her medical files showed that tests (including complete blood count, fibrinogen level, prothrombin time, thrombin time, platelet count, serum chemistry test, erythrocyte sedimentation rate, stool antigen test for Helicobacter pylori, thyroid hormone tests, thyroid-stimulating hormone test, thyroperoxidase antibodies, and allergy tests) were all within normal limits, and electrocardiography and chest radiography were normal.Abdominal ultrasound, performed several times during the abdominal attacks, showed ascites, but ultrasound and CT scan of the abdomen during asymptomatic periods were unremarkable.Because of the recurrent nature of her colicky pain, she decided together with a surgeon to undergo a laparoscopic investigation during such an attack at the age of 29 years.Severe abdominal attacks can mimic an acute abdomen, and patients are often seen in the emergency department.3 Although 95% of cases of ascites are caused by cirrhosis, congestive heart failure, cancer, or constrictive pericarditis, the remaining 5% form a long list of rare disorders, including C1-inhibitor deficiency.4 Abdominal pain from submucosal oedema of the bowel wall is a characteristic but often ignored feature of this disorder.