Giant villous adenoma presenting as McKittrick–Wheelock syndrome and pseudo‐obstruction

Miles, Lachlan F; Wakeman, Christopher; Farmer, K. C. R.

doi:10.5694/j.1326-5377.2010.tb03484.x

Cited by 20 publications

(8 citation statements)

References 13 publications

(11 reference statements)

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“…They are situated primarily in the rectum and occasionally in the sigmoid colon, as in the present case [1,4,5]. The large size allows more surface area for secretion, and the distal location of these lesions means a minimal area of normal colonic mucosa remains to allow fluid absorption, resulting in depletion syndrome [6].…”

Section: Discussionmentioning

confidence: 93%

A case of giant rectal villous tumor with severe fluid-electrolyte imbalance treated by laparoscopic low anterior resection

et al. 2012

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McKittrick-Wheelock syndrome is a disorder caused by fluid and electrolyte hypersecretion from a colorectal tumor. To present the case of a patient with a giant rectal villous tumor with McKittrick-Wheelock syndrome who was successfully treated with laparoscopic surgery. The case of a 59-year-old man who came to the emergency department with syncope, prerenal azotemia, and electrolyte disturbances with a background of chronic diarrhea is reported. His condition was the result of fluid and electrolyte hypersecretion caused by rectal villotubular adenomas. Laparoscopic low anterior resection and subsequent volume and electrolyte replacement therapy resulted in complete recovery. A microscopic examination revealed multiple, well-differentiated adenocarcinomas arising in villotubular adenomas. Laparoscopic surgical resection is a feasible therapeutic modality for McKittrick-Wheelock syndrome.

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Section: Discussionmentioning

confidence: 93%

A case of giant rectal villous tumor with severe fluid-electrolyte imbalance treated by laparoscopic low anterior resection

et al. 2012

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“…The description of diarrhoea may change from patient to patient, with some reporting profuse diarrhoea of more than 10 loose, watery bowel movements per day, while others describe a rectal mucous discharge,12 or clear mucus stools,13 instead of using the word ‘diarrhoea’. Additionally, patients may present with signs of intestinal obstruction or pseudo-obstruction rather than diarrhoeal illness 14 15. Other presentations seen in the literature include:14 16 acute kidney injury, syncope, hypovolaemic shock, weakness, dermatomyositis, rectal prolapse or rectal intussusception.…”

Section: Discussionmentioning

confidence: 99%

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

Kagan¹,

Schmidt

Sangha³

2017

BMJ Case Reports

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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.

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“…1 The principal diagnostic criteria include secretory diarrhea with electrolyte and fluid depletion syndrome (which can go as far as prerenal acute renal failure and metabolic acidosis, 1 such as in our case), associated with large rectal villous adenoma (more than 3-4 cm diameter). 2,3 This hypersecretory function seems to be linked to excessive prostaglandin E 2 production, resulting in disproportionate water, sodium, and potassium secretion, the volume of which was higher than the amount of saline solution fluids our patient received. 1 The pathophysiology of the colonic distension in this context is not yet fully understood and would be caused by electrolyte dysfunction rather than tumoral obstruction.…”

mentioning

confidence: 85%

The Case | Acute renal failure and refractory hyponatremia

Denis

Jadot

Bouquegneau

et al. 2016

Kidney International

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Giant villous adenoma presenting as McKittrick–Wheelock syndrome and pseudo‐obstruction

Cited by 20 publications

References 13 publications

A case of giant rectal villous tumor with severe fluid-electrolyte imbalance treated by laparoscopic low anterior resection

A case of giant rectal villous tumor with severe fluid-electrolyte imbalance treated by laparoscopic low anterior resection

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

The Case | Acute renal failure and refractory hyponatremia

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