Hypersecretory Villous Adenoma as the Primary Cause of Intestinal Intussusception and Mckittrick-Wheelock Syndrome

García, Susana Sánchez; Campos, Pedro Villarejo; Campillo, María del Carmen Manzanares; Rendo, Aurora Gil; Atienza, Virginia Muñoz; Santos, Esther Pilar García; García, Francisco Martín; Puche, José Luis Bertelli

doi:10.1155/2013/252156

Cited by 12 publications

(10 citation statements)

References 15 publications

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“…While most colonic polyps are asymptomatic, severe secretory diarrhea has been reported in the past caused due to the presence of colonic adenomas [7,8]. In general, tubular colon adenomas are known to be precancerous and could undergo malignant transformation.…”

Section: Discussionmentioning

confidence: 99%

“…When a polyp has >75% villous features, it is classifed as a villous adenoma. Tubulovillous adenomas are, as the name suggests, adenomas that carry both tubular and villous features [8]. Malignancy risk tends to increase linearly with an increase in the size of the polyp, positive family history of colon cancer, histological type, and degree of dysplasia [10,11].…”

Section: Discussionmentioning

confidence: 99%

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McKittrick–Wheelock Syndrome: A Rare Case of Secretory Diarrhea

Rayad

Mirza

Herrera-Gonzalez

et al. 2022

Case Reports in Gastrointestinal Medicine

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McKittrick–Wheelock syndrome commonly presents with a triad of chronic secretory diarrhea, electrolyte disturbances, and renal failure. Secretory diarrhea is due to active ion secretion secondary to secretagogue secretion (cyclic adenosine monophosphate and prostaglandin E2). The mainstay of treatment for these lesions is surgical since it will arrest the loss of electrolytes that may lead to serious clinical consequences. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin may be used to decrease electrolyte secretion in patients that desire a nonsurgical approach. Our patient is unique in that this is the first case of a tubular adenoma with high-grade dysplasia leading to MWS and progressing to circulatory collapse with severe electrolyte disturbances. Aggressive replacement of fluids and electrolytes is essential to the survival of these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

McKittrick–Wheelock Syndrome: A Rare Case of Secretory Diarrhea

Rayad

Mirza

Herrera-Gonzalez

et al. 2022

Case Reports in Gastrointestinal Medicine

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Caron

Dubrûle

Letarte

et al. 2019

Case Reports in Gastrointestinal Medicine

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A rare combination of severe volume depletion and electrolyte imbalance caused by a rectal villous adenoma is often referred to as the McKittrick-Wheelock syndrome. Patients usually seek medical care because of chronic hypersecretory diarrhea and display renal failure, metabolic acidosis, hyponatremia, and hypokalemia. We report the case of a 68-year-old woman who presented with this condition but showed unusual features such as severe hypokalemia and metabolic alkalosis, without diarrhea. She subsequently underwent transanal endoscopic microsurgery (TEMS), an innovative procedure in the management of large rectal adenomas. We also provide a narrative review of the literature on this rare entity.

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“…Colorectal villous adenomas occur most commonly in the rectum and are typically asymptomatic. However, some villous adenomas, those in the distal rectum in particular, may be hypersecretory, and when large amounts of mucus are secreted into the lumen, diarrhea can result (47)(48)(49). Uncontrolled diarrhea may lead to fluid, protein, and electrolyte abnormalities, potassium depletion in particular.…”

Section: Colorectal Lesionsmentioning

confidence: 99%

“…Large tumors can also cause obstructive symptoms, which are occasionally related to prolapse or intussusception (47). These tumors can manifest during the workup for anemia due to occult bleeding, or patients may develop overt rectal bleeding or melena, although this is less common.…”

Section: Colorectal Lesionsmentioning

confidence: 99%

Villous Gastrointestinal Tumors: Multimodality Imaging with Histopathologic Correlation

Lubner¹,

Menias

Johnson

et al. 2018

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Villous lesions are advanced adenomas that manifest most commonly in the colon; however, they can develop throughout the gastrointestinal tract. The duodenum is the most common small-bowel site of these lesions. Although in most cases these are isolated lesions that occur sporadically, patients with certain specific colorectal cancer syndromes, including familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, may develop multiple advanced adenomas. Villous lesions are important because although they are histologically benign, they may harbor dysplasia and have potential for malignancy. These characteristics make them a primary target for colorectal cancer screening with optical and virtual colonoscopy. However, these lesions can also be symptomatic and detected at diagnostic imaging when patients present for examination. They have characteristic features at a variety of imaging examinations, including barium fluoroscopy, CT, MRI, and endoscopic US. It is important for radiologists to be aware of these lesions, their potential morphologies, and their typical appearances at multimodality imaging. Although villous tumors can be detected at imaging and confirmed with biopsy, owing to limitations in identifying dysplasia and foci of malignancy with the above modalities alone and the potential for malignancy, referral for surgical resection of these lesions ultimately is required. RSNA, 2018.

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Hypersecretory Villous Adenoma as the Primary Cause of Intestinal Intussusception and Mckittrick-Wheelock Syndrome

Cited by 12 publications

References 15 publications

McKittrick–Wheelock Syndrome: A Rare Case of Secretory Diarrhea

McKittrick–Wheelock Syndrome: A Rare Case of Secretory Diarrhea

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

Villous Gastrointestinal Tumors: Multimodality Imaging with Histopathologic Correlation

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