A case of giant rectal villous tumor with severe fluid-electrolyte imbalance treated by laparoscopic low anterior resection

Abstract

McKittrick-Wheelock syndrome is a disorder caused by fluid and electrolyte hypersecretion from a colorectal tumor. To present the case of a patient with a giant rectal villous tumor with McKittrick-Wheelock syndrome who was successfully treated with laparoscopic surgery. The case of a 59-year-old man who came to the emergency department with syncope, prerenal azotemia, and electrolyte disturbances with a background of chronic diarrhea is reported. His condition was the result of fluid and electrolyte hypersecretion caused by rectal villotubular adenomas. Laparoscopic low anterior resection and subsequent volume and electrolyte replacement therapy resulted in complete recovery. A microscopic examination revealed multiple, well-differentiated adenocarcinomas arising in villotubular adenomas. Laparoscopic surgical resection is a feasible therapeutic modality for McKittrick-Wheelock syndrome.

Síndrome de McKittrick-Wheelock. Una causa infrecuente de hipokalemia e injuria renal aguda. Caso clínico

“…En los casos publicados, la duración de la diarrea a menudo ha sido prolongada, variando entre 1 mes y 10 años (promedio 23 meses) 1 . Los enterocitos normales reabsorben agua, sodio y bicarbonato y secretan potasio 8 . Las células intestinales del adenoma velloso hipersecretor tienen un intercambiador de bicarbonato en su superficie apical inapropiadamente activado, llevando a depleción de bicarbonato, además de potasio, sodio y agua 4 .…”

A case of rectal villous adenoma in a female patient presenting with chronic diarrhea and acute renal failure

“…Complications range from dehydration, asthenia and tachycardia up to profound acute renal injury and myocardial affection in the form of fatal arrhythmias [1,2]. It was found that up to 80 % of these villous adenomas have been reported to host foci of adenocarcinoma, making the most appropriate treatment is complete surgical excision of the lesion to decrease the chance of cancer and to resolve the depletion syndrome, also Surgical polypectomy is advised if the polyp is larger than 3 cm or sessile as villous adenomas often are [12].…”

“…First described in 1954 McKittrick-Wheelock syndrome a triad of and electrolyte depletion, Dehydration, mucous diarrhea cause by a secretory colorectal adenoma or adenoncarcinoma [1] presenting with symptoms of hyponatremia ranging from gastrointestinal upset up to seizures and coma, hypokalemia with fatique and ileus up to cardiac dysfunction and arrythmias and hypotension [2][3][4][5]. Current management strategies include prompt and aggressive fluid and electrolyte replacement till normalization of kidney functions and improvement of general condition thus preventing the often-grave complications of this hydroelectrolytic imbalance on organs followed by immediate curative surgical resection or endoscopic resection of the colorectal mass depending on the characteristics of the mass that include size, site and accessibility [6][7][8].…”

Mckittrick-Wheelock Syndrome: A Case Report

“…Laparoscopic surgical resection is also a feasible therapeutic modality for select cases of MckittrickWheelock syndrome [11].…”