A case of rectal villous adenoma in a 28 year old female patient presenting with Depletion syndrome

Abstract

Secretory villous adenoma is one of the rare causes of severe secretory diarrhea, acute kidney injury and refractory electrolyte imbalance is the classic triad of this disorder named McKittrick-Wheelock syndrome. Aggressive hydroelectrolyte rebalancing is often needed, and curative treatment is obtained only with complete removal of the lesion, by endoscopic resection or surgery. High clinical suspicion in patients with severe dehydration due to secretory diarrhea and concomitant electrolyte imbalance is both mandatory and essential for early diagnosis and treatment before complications arise. In this case we describe a female patient suffering from 6 months of secretory diarrhea, presented to our emergency department with severe dehydration, acute renal failure, hyponatremia and hypokalemia. After rehydration and electrolyte replacement, confirmation of the diagnosis was done by colonoscopy and biopsy showing 3 sessile colonic polyps (2 at distal end of Transverse colon, largest one at descending colon) the biopsy confirmed the presence of villous adenoma with high grade dysplasia. Normalization of the electrolyte imbalance and the kidney functions was done and she was successfully treated with surgical resection that lead to complete resolution of sympt oms. McKittrick-Wheelock syndrome is a rare life threatening depletion syndrome that can lead to acute kidney injury and electrolyte imbalance with concomitant organ damage. Early management by vigorous repletion therapy and curative surgical resection will mostly resolve the symptoms and complications.