Acute Renal Failure in Association with Community-Acquired <i>Clostridium difficile</i> Infection and McKittrick-Wheelock Syndrome

Abstract

We report the case of a 65-year-old Caucasian woman who experienced two separate episodes of acute renal failure within an 18-month period, both requiring emergency admission and complicated treatment. Each episode was precipitated by hypovolaemia from intestinal fluid losses, but from two rare and independent pathologies. Her first admission was attributed to community-acquired Clostridium difficile-associated diarrhoea (CDAD) and was treated in the intensive therapy unit. She returned 18 months later with volume depletion and electrolyte disturbances, but on this occasion a giant hypersecretory villous adenoma of the rectum (McKittrick-Wheelock syndrome) was diagnosed following initial abnormal findings on digital rectal examination by a junior physician. Unlike hospital-acquired C. difficile, community-acquired infection is not common, although increasing numbers are being reported. Whilst community-acquired CDAD can be severe, it rarely causes acute renal failure. This case report highlights the pathological mechanisms whereby C. difficile toxin and hypersecretory villous adenoma of the rectum can predispose to acute renal failure, as well as the values of thorough clinical examination in the emergency room, and early communication with intensivist colleagues in dire situations.

McKittrick-Wheelock Syndrome Presenting with Acute Kidney Injury and Metabolic Alkalosis: Case Report and Narrative Review

“…A vast majority of patients reported nonbloody diarrhea of variable duration. When mentioned, more patients were acidotic at presentation [9–13]. Malignant pathology (adenocarcinoma) was found in 18% of examined tumors.…”

Transanal total mesorectal excision of giant villous tumor of the lower rectum with McKittrick–Wheelock syndrome: a case report of a novel surgical approach

“…The procedures could lead to severe complication such as anastomotic leakage, urinary dysfunction, and surgical site infection [15, 19–24]. Especially in the case of tumors located in the lower rectum, we cannot avoid choosing abdominal–peritoneal resection, which reduces the patient’s quality of life dramatically [10, 25]. The technique is sometimes too invasive; thus, we focused on TaTME as a less-invasive anal-preserving surgery.…”

Indomethacin therapy effective in a patient with depletion syndrome from secretory villous adenoma

“…Commonly, a patient will present with diarrhoea as some part of their history, but that diarrhoea may be chronic in nature occurring over 10–15 years,10 11 whereas others have a more recent onset of diarrhoea. The description of diarrhoea may change from patient to patient, with some reporting profuse diarrhoea of more than 10 loose, watery bowel movements per day, while others describe a rectal mucous discharge,12 or clear mucus stools,13 instead of using the word ‘diarrhoea’. Additionally, patients may present with signs of intestinal obstruction or pseudo-obstruction rather than diarrhoeal illness 14 15.…”