Hereditary Angioedema with Successful Low Anterior Resection of Rectal Carcinoid

Abstract

Hereditary angioedema (HAE) is a disease with symptoms of abdominal pain or dyspnea caused by local edema. Therefore, caution is required in perioperative care when HAE patients are placed under general anesthesia, which requires intratracheal intubation. We report a case of rectal carcinoid complicated with HAE, where low anterior resection was performed safely using novel perioperative care techniques. A 60-year-old man presented at our hospital complaining of hematochezia. He was diagnosed with rectal carcinoid on the basis of colonoscopy findings, in which surgery was indicated because the tumor was 20 mm. He had a history of hospitalization for abdominal pain and a family history of edema attack. HAE was confirmed on the basis of patient history, family history, serum complement value, and the low activity of the C1 inactivator. He underwent low anterior resection under epidural and spinal anesthesia after administration of danazol, tranexamic acid, and C1 inactivator. His postoperative course was uneventful without edema attack.