Chronic Diarrhea with Renal Insufficiency and Electrolyte Disturbances due to a Large Rectal Polyp

Abstract

Large villous adenomas in the distal colon can cause chronic secretory diarrhea evolving to severe electrolyte depletion, hypovolemia and renal insufficiency. This rare clinical presentation is known as the McKittrick-Wheelock syndrome (MWS) and can lead to death if not treated adequately. The main pathophysiological mechanisms in the development of MWS are the increased mucus production by the polyp, cyclic adenosine monophosphate (cAMP) mediated potassium (K+), chloride (Cl-) and sodium (Na+) loss and the insufficient colon reabsorption capacity as a result of the distal location of the polyp in the colon. We report a 74 year old woman with the McKittrick-Wheelock syndrome and review previously published reports to get a deeper insight into the pathophysiological mechanisms.