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

Abstract

This paper details the case of a 26-year-old woman with depletion syndrome and the effectiveness of her treatment with indomethacin. Villous adenomas are benign neoplasms with a high incidence of becoming malignant. A small percentage of villous adenomas are known to cause depletion syndrome, also referred to as the McKittrick-Wheelock syndrome, a condition characterised by secretory diarrhoea, dehydration, hyponatremia, hypokalaemia, hypochloraemia, metabolic acidosis and acute renal failure. Prostaglandin-E2 mediates the hypersecretion mechanism observed in depletion syndrome, and can be inhibited by cyclo-oxygenase inhibitors. This case study measured the effectiveness of prostaglandin inhibition on a patient with oral and parenteral electrolyte replacement refractory depletion syndrome. Fluid loss and prostaglandin levels were measured before and after pharmacological treatment. This case demonstrates a 49% decrease in rectal effluent and a marked commensurate decrease in daily replenishment requirements within 48 hours of indomethacin treatment initiation, resulting in subsequent electrolyte stabilisation.

The McKittrick-Wheelock syndrome: A rare case with a complex acid-base disorder

“…6,8 Some studies have shown the usefulness of indomethacin and somatostatin especially for poor surgical candidate. 4,9,10 The case we described meets the diagnostic criteria of MKS, such secretory diarrhea due to villous adenoma, acute renal failure and electrolyte and acid-base disorders. Clinical features were similar to those already reported in literature.…”

“…6,7 According to literature most of reported cases are due to villous adenoma, with some cases secondary to adenocarcinoma or neuroendocrine tumor. 8 Only a little percentage (0.76-2.4%) of villous adenomas become secretory 4 and the etiopathogenesis of this process is not completely clear. Secretory and nonsecretory villous adenomas show differences on microscopic and ultrastructural examinations.…”

“…This rare syndrome is characterized by secretory diarrhea, often without pain, caused by a secretory colorectal tumor, most notably villous adenomas. 2,3 Adenomas of the colon are usually asymptomatic or cause mild gastrointestinal symptoms, but a range from 0.76-2.4% of them could become secretory 4 leading, potentially, to a severe loss of fluid and electrolyte due to a mucinous diarrhea. The consequences are severe dehydration with acute renal failure, significant electrolyte abnormalities and acid-base imbalance, making MWS a potentially lethal condition.…”

“…The consequences are severe dehydration with acute renal failure, significant electrolyte abnormalities and acid-base imbalance, making MWS a potentially lethal condition. 2,3 Over 100 cases of MWS have been reported in literature, 4 despite that some authors believe it is not rare as often thought. 5 Considering that MWS is a potential life-threatening condition it's essential to include it in the work up of a patient with diarrhea, depletion syndrome, electrolyte and acid-base abnormalities.…”

Does Attenuated Mckittrick-Wheelock Syndrome Exists?

“…In the literature, endoscopic submucosal dissection has been reported to be feasible and useful for MWS treatment (8). In another study, it was reported that the symptoms of MWS may be reduced 48 hours after the start of indomethacin therapy (9). Transabdominal laparoscopic procedures are the most described methods in the treatment of MWS.…”