Mckittrick–Wheelock syndrome: an often, overlooked complication of rectal adenomas

Kapoor, Shailendra

doi:10.1007/s00464-014-3462-5

Cited by 5 publications

(6 citation statements)

References 7 publications

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“…The mechanism behind these symptoms is suggested to involve cyclic adenosine monophosphate (AMP) and prostaglandin E2 acting as mediators, which increase the loss of fluid and electrolytes from plasma to the intestinal lumen [14]. Endoscopic findings of tumors that cause MWS indicate that they are large, villous and mucus-rich [2,3,10,12,13,15,16], which we saw in the present case. Villous tumors are characterized by a structure of finger-like projections composed of loose vascular connective tissues covered by a single layer of columnar epithelial cells.…”

Section: Discussionmentioning

confidence: 59%

Electrolyte depletion syndrome (McKittrick–Wheelock syndrome) successfully treated by endoscopic submucosal dissection

Ohara

Toyonaga

Watanabe

et al. 2015

Clin J Gastroenterol

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A 66-year-old woman presented to us with malaise, anorexia and rectal mucous discharge, and her laboratory data showed severe hyponatremia, hypokalemia, hypochloremia and renal failure. Computed tomography revealed massive occupation of the rectum by a large tumor. Colonoscopy revealed a mucus-rich villous tumor in the rectum. As there were no other factors that could cause an electrolyte disorder, she was diagnosed with McKittrick-Wheelock syndrome (MWS). The current standard treatment for MWS is partial surgical colectomy. However, surgeries are invasive and postoperative complications sometimes become an issue. After confirming no signs of submucosal invasion of the tumor by magnifying chromoendoscopic examination, endoscopic submucosal dissection (ESD) was indicated. The tumor was completely removed en bloc without adverse events. The histology showed a mucosal adenocarcinoma containing a villous component, 24.5 x 17.0 cm in size. This removal dramatically improved the patient's symptoms and the electrolyte abnormalities without medication. Although several sessions of endoscopic balloon dilation were required to treat postoperative stricture, she has been symptom-free and had no recurrence for 4 years after treatment. We experienced a case of MWS treated by ESD instead of surgery. ESD should be feasible and beneficial for the treatment of MWS.

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Section: Discussionmentioning

confidence: 59%

Electrolyte depletion syndrome (McKittrick–Wheelock syndrome) successfully treated by endoscopic submucosal dissection

Ohara

Toyonaga

Watanabe

et al. 2015

Clin J Gastroenterol

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“…MWS is more likely to be present in large adenomas where they generate significant amounts of electrolyte-containing mucin. The pathophysiology could be explained by the fact that giant adenoma has a huge surface area, which secretes more fluid than the remaining normal rectal mucosa can reabsorb, and results in chronic watery diarrhea [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

McKittrick–Wheelock Syndrome: A Case Report

2023

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An adenoma is the most typical large bowel tumor found in 30% of all screening colonoscopies. However, it is often asymptomatic but sometimes might lead to abdominal pain or bleeding of the rectum. Critical electrolyte disbalance and acute kidney injury caused by secretory diarrhea is an untypical clinical manifestation of adenoma. It has rarely been reported in the literature and is defined as McKittrick–Wheelock syndrome. A 61-year-old patient was hospitalized for heavy dyselectrolytemia, diarrhea, acute kidney injury, sepsis, and fever. After the renal function was corrected and electrolyte imbalance persisted, visual instrumental diagnostics tests revealed a large tumor in the sigmoid colon. Subsequently, the patient underwent surgical resection, which exhibited evidence of tubulovillous adenoma on pathology. The atypical signs of McKittrick–Wheelock syndrome and comorbidities can make the diagnostics challenging. When severe hyponatremia and hypokalemia are followed by persistent mucous diarrhea, the clinicians should suspect MWS as a possible reason for it.

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“…The diagnostic delay can be very harmful, and can provoke chronic renal failure and/or cardiac arrhythmias. 1 2…”

Section: Discussionmentioning

confidence: 99%

“…The diagnostic delay can be very harmful, and can provoke chronic renal failure and/or cardiac arrhythmias. 1,2 McKittrick-Wheelock syndrome is frequently related to a villous adenoma; however, rarely, it can be secondary to malignant tumors. Malik et al 7 (2016) reviewed the features of 35 cases of MKWS, and reported that 22 had a villous adenoma, 8 cases had an underlying adenocarcinoma, 1 case had a hyperplastic polyp, and 1 case had a neuroendocrine tumor of the rectum with liver metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…Originally described in 1954, McKittrick-Wheelock syndrome (MKWS) is a rare syndrome characterized by a triad of conditions, including acute kidney failure and an electrolytic disorder associated with chronic diarrhea due to an underlying large distal colorectal tumor, most commonly a villous adenoma. 1 2 3 A hypersecretory state secondary to a large villous adenoma is responsible for most of the syndrome's signs and symptoms, and its cause is due to the secretion of a large amount of fluid which overwhelms the reabsorption capacity of the colorectal mucosa. 4…”

Section: Introductionmentioning

confidence: 99%

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McKittrick-Wheelock Syndrome Secondary to Rectal Adenocarcinoma

Martins

Gomes

Santos

et al. 2022

Journal of Coloproctology

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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.

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Mckittrick–Wheelock syndrome: an often, overlooked complication of rectal adenomas

Cited by 5 publications

References 7 publications

Electrolyte depletion syndrome (McKittrick–Wheelock syndrome) successfully treated by endoscopic submucosal dissection

Electrolyte depletion syndrome (McKittrick–Wheelock syndrome) successfully treated by endoscopic submucosal dissection

McKittrick–Wheelock Syndrome: A Case Report

McKittrick-Wheelock Syndrome Secondary to Rectal Adenocarcinoma

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