McKittrick-Wheelock Syndrome Secondary to Rectal Adenocarcinoma

Abstract

Introduction McKittrick-Wheelock syndrome is a rare condition that arises from a hypersecretory state secondary to large colorectal tumors, mainly villous adenomas, leading to an electrolytic disorder associated with chronic diarrhea that usually persists for years. It is a relatively unknown disease that can lead to severe complications such as acute kidney injury, severe hyponatremia, and hypokalemia. In fact, it causes death in most untreated cases. Surgical removal of the tumor is the most successful treatment, and symptoms tend to disappear after proper management. Case Report A 62-year-old man with a 2-year history of mucoid diarrhea preceded by abdominal pain presented with acute kidney injury, hyponatremia, and hypokalemia. A digital rectal examination and sigmoidoscopy were performed, and revealed a large laterally-spreading tumor in the rectum. Further investigation showed a rectal tubulovillous adenoma with secondary McKittrick-Wheelock syndrome. An anterior resection of the rectum with a colonic J-pouch and a diverting ileostomy were performed, and the patient improved with the resolution of the renal failure and electrolyte disturbances. The histopathological analysis revealed an invasive rectal adenocarcinoma. Discussion McKittrick-Wheelock syndrome is a condition with a low incidence that needs early intervention and proper diagnosis. It is of extreme importance that this disease is included in the differential diagnoses for chronic diarrhea associated with an electrolytic disorder.

McKittrick Wheelock Syndrome Secondary to Adenocarcinoma of the Rectum. Case Report and Diagnostic Considerations

“…This syndrome is associated with large tumors, generally larger than 3 cm, which have a higher risk of malignant transformation, since 50% of villous adenomas larger than 2 cm are carriers of invasive cancer. 2 3…”

“…This last stage of decompensation is usually the cause of admission and investigation for hydroelectrolytic and metabolic imbalances, specifically acute kidney injury with hyponatremia and hypokalemia, if the tumor mass was not detected or addressed in previous evaluations. 1 2 3 4 5 6…”

“…This last stage of decompensation is usually the cause of admission and investigation for hydroelectrolytic and metabolic imbalances, specifically acute kidney injury with hyponatremia and hypokalemia, if the tumor mass was not detected or addressed in previous evaluations. [1][2][3][4][5][6] Treatment Treatment consists of resuscitation with intravenous fluids, correction of electrolyte imbalance and surgical resection as definitive treatment.…”

“…McKittrick-Wheelock syndrome, described in 1954, is a low incidence entity, benign in most cases, characterized by a secretory villous adenoma accompanied by acute renal injury and hydroelectrolytic imbalance. 1 2…”

“…McKittrick-Wheelock syndrome, described in 1954, is a low incidence entity, benign in most cases, characterized by a secretory villous adenoma accompanied by acute renal injury and hydroelectrolytic imbalance. 1,2 Regarding epidemiology, the population usually affected are elderly men, who complain of long lasting watery non-bloody diarrhea with mucus. Patients usually report symptoms of several months of duration, presenting severe hyponatremia and hypokalemia, discovered at the time of the approach.…”