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

Abstract

BackgroundMcKittrick–Wheelock syndrome (MKWS) is caused by a villous tumor of the rectosigmoid colon with hypersecretion of mucus containing electrolytes. Complete resection of the tumor is needed to cure this disease. Transanal total mesorectal excision (TaTME) is currently a promising treatment for lower rectal tumor because of the reliability of its resection margin especially in bulky tumor. We present this first case report of a TaTME for MKWS with a lower rectal tumor.Case presentationAn 81-year-old woman was admitted to our hospital with diarrhea and acute renal failure. Computed tomography and magnetic resonance imaging examinations revealed an 80-mm-sized enhanced tumor located in her lower rectum without lymph node swelling and distant metastasis. A giant villous tumor secreting mucus was seen in the lower rectum to the anal canal during colonoscopy. The result of tumor biopsy was adenocarcinoma. To preserve the anal function and ensure distal margin, we chose TaTME for curative resection. After improving the electrolyte imbalance, TaTME was performed successfully and R0 resection was achieved. There was no sign of recurrence or electrolyte depletion for 1 year after the surgery.ConclusionTaTME could be a promising surgical approach for giant villous tumor with MKWS in the lower rectum.

Transanal total mesorectal excision for treating a lower rectal inflammatory myofibroblastic tumor: A case report

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TaTME approach as a rescue during a laparoscopic TME for high rectal cancer. A case report

“…This procedure could be performed in inflammatory bowel disease patients for a completion proctectomy to overcome some limitations of the traditional minimally invasive techniques, allowing better visualization in the low pelvis and easier dissection of the distal 5 cm of the rectum [ 11 ]. The described clinical benefits of TaTME are low circumferential margin positive rates, less morbidity and more sphincter-saving rectal resections compared to laparoscopic TME [ 12 ]. Some intraoperative complications for example urethral injury, were described, but all advantages make this surgical approach a good alternative to the laparoscopic and the robotic approaches.…”

Laparoscopic Proctocolectomy With Transanal Total Mesorectal Excision for Ulcerative Colitis

“…TaTME improves surgical manipulation and minimizes the risk of local recurrence by ensuring a CRM using TME. This is particularly of value for patients in whom transabdominal surgery is technically challenging, such as in patients with extensive adhesions, giant tumors, a narrow pelvis, and lower rectal cancers [ 1 , 2 , 8 ]. The TaTME Registry Collaborative database reported outcomes of 2,653 consecutive patients who underwent TaTME.…”