McKittrick–Wheelock Syndrome: A Case Report

Abstract

An adenoma is the most typical large bowel tumor found in 30% of all screening colonoscopies. However, it is often asymptomatic but sometimes might lead to abdominal pain or bleeding of the rectum. Critical electrolyte disbalance and acute kidney injury caused by secretory diarrhea is an untypical clinical manifestation of adenoma. It has rarely been reported in the literature and is defined as McKittrick–Wheelock syndrome. A 61-year-old patient was hospitalized for heavy dyselectrolytemia, diarrhea, acute kidney injury, sepsis, and fever. After the renal function was corrected and electrolyte imbalance persisted, visual instrumental diagnostics tests revealed a large tumor in the sigmoid colon. Subsequently, the patient underwent surgical resection, which exhibited evidence of tubulovillous adenoma on pathology. The atypical signs of McKittrick–Wheelock syndrome and comorbidities can make the diagnostics challenging. When severe hyponatremia and hypokalemia are followed by persistent mucous diarrhea, the clinicians should suspect MWS as a possible reason for it.

Endoscopic Submucosal Dissection of a Giant Rectal Adenoma Manifesting as McKittrick-Wheelock Syndrome

“…There are undoubtedly cases of locally advanced malignant tumors or mechanical complications, such as intussusception and massive rectal prolapse, where surgery is the only suitable treatment, and careful clinical examination and tumor staging are essential for the identification of such patients [45,46,47]. Very large tumors situated in the upper sigmoid colon might also be suitable for surgery since the position of the endoscope is unstable and the ESD procedure is highly demanding, while laparoscopic sigmoidectomy is associated with low morbidity and very rarely requires an ostomy [48,49]. But apart from those rare cases, we strongly believe that endoscopic resection and particularly ESD should be considered as the treatment of choice for large rectal lesions associated with MKWS.…”