McKittrick-Wheelock Syndrome: A Rare Cause of Chronic Diarrhea

Abstract

Diarrhea is the principal cause of the majority of healthcare utilization. When diarrhea lasts longer than four weeks, it is considered chronic diarrhea. There are several causes of chronic diarrhea, but here we focus on one of the rare causes, known as McKittrick-Wheelock syndrome (MWS). We here present the case of a patient in his seventies with chronic diarrhea, found to have tubulovillous adenoma and diagnosed with McKittrick-Wheelock syndrome. We also discuss the clinical presentation, pathophysiology, and management of MWS.

McKittrick–Wheelock Syndrome: A Case Report

“…Recently published studies have shown an increase in the usage of minimally invasive procedures such as transanal endoscopic microsurgery, transanal minimally invasive surgery, endoscopic mucosal resection, and endoscopic submucosal dissection [ 21 , 22 ]. However, some authors noticed that the risk of recurrence is greater after minimally invasive operations [ 4 , 9 , 18 ]. Endoscopic techniques may be technically challenging due to the large size of the tumor in MWS patients [ 18 ].…”

“…The largest systematic study revealed a long duration of symptoms and severe electrolyte imbalances for patients with MWS [ 8 ]. However, the real prevalence of MWS in combination with colon adenoma is unknown [ 8 , 9 ].…”

McKittrick-Wheelock Syndrome: A Rare Cause of Potentially Fatal Chronic Diarrhea

“…As tumor size increases, enteral losses worsen, thus overloading compensation mechanisms. 11,31 Hypersecretory villous adenomas are capable of generating notable hydroelectrolytic disturbances, as these tumors can cause a rectal loss of 4 liters a day, containing on average 120 mmol per liter of sodium, 4.4 mmol per liter of potassium and 123 mmol per liter chloride. At first, there is the possibility of balancing the deficit of electrolytes and fluids through greater oral intake and renal adaptation.…”

“…Subsequently, it is crucial to remove the tumor through surgery or endoscopy, which is the basis of treatment. 2,3,11,30,31 One study showed that patients who underwent endoscopic resection occasionally required further resection surgery or additional endoscopic techniques to achieve total resection. It was notable that, according to the tumor dimensions, there was an increase in the technical complexity of the endoscopic approach.…”

“…One study demonstrated that the average frequency of bowel movements was ten per day, being higher in patients who died in the future when compared to those who survived. 11,12,25 There are reports of patients with watery or mucous diarrhea that persist for a long time, sometimes being clinically resolved in the initial phase. Faced with a rectal adenoma causing secretory diarrhea, the condition becomes severe enough to trigger pre-renal acute kidney injury and electrolyte disturbance, significantly worsening the patient's outcome, progressing to the deterioration phase and later to the decompensation phase, the which has a high mortality if not treated properly.…”