McKittrick-Wheelock Syndrome (Electrolyte Depletion Syndrome)

Matsuura, N.; Kawano, Ayako; Tai, Hiroshi; Imamura, Takuroh

doi:10.2169/internalmedicine.56.7925

Cited by 3 publications

(3 citation statements)

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“…There are undoubtedly cases of locally advanced malignant tumors or mechanical complications, such as intussusception and massive rectal prolapse, where surgery is the only suitable treatment, and careful clinical examination and tumor staging are essential for the identification of such patients [45,46,47]. Very large tumors situated in the upper sigmoid colon might also be suitable for surgery since the position of the endoscope is unstable and the ESD procedure is highly demanding, while laparoscopic sigmoidectomy is associated with low morbidity and very rarely requires an ostomy [48,49]. But apart from those rare cases, we strongly believe that endoscopic resection and particularly ESD should be considered as the treatment of choice for large rectal lesions associated with MKWS.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Endoscopic Submucosal Dissection of a Giant Rectal Adenoma Manifesting as McKittrick-Wheelock Syndrome

Kouladouros,

Schneider,

Kubicka

et al. 2023

Z Gastroenterol

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McKittrick–Wheelock syndrome (MKWS) is an uncommon clinical manifestation of large, villous, epithelial lesions of the distal colon and rectum. Excessive secretion of electrolyte-rich mucus from these lesions leads to secretory diarrhea, electrolyte disorders and acute renal failure. Several cases of MKWS have been reported since its initial description in 1954. The definitive treatment for the great majority of MKWS cases has consisted of surgical resection of the affected part of the colorectum, usually in the form of a low anterior resection or an abdominoperineal resection with the formation of an ostomy. Recent developments in endoscopic resection techniques now offer new, minimally invasive treatment alternatives for MKWS patients. We present the first reported case in the Western world of MKWS caused by a rectal adenoma with a size of 19 × 10 cm, treated through endoscopic submucosal dissection. Through the lessons learned by this case, as well as by a thorough review of the literature, we discuss this uncommon syndrome, focusing on treatment alternatives.

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Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Endoscopic Submucosal Dissection of a Giant Rectal Adenoma Manifesting as McKittrick-Wheelock Syndrome

Kouladouros,

Schneider,

Kubicka

et al. 2023

Z Gastroenterol

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“…Over time, the compensation mechanisms cease, triggering dehydration and electrolyte imbalance, which can be potentially fatal. 10,18,28 Most colonic secretory villous adenomas generate hyperchloremic metabolic acidosis due to the large amount of liquid rich in bicarbonate and potassium. Added to this, the abundance of lactate and acute kidney injury may cooperate for acidosis.…”

Section: 192428mentioning

confidence: 99%

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

Michelini¹,

Alvarez²

2023

JHS

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McKittrick-Wheelock syndrome is characterized by a state of extreme fluid and electrolyte depletion secondary to large colorectal tumors, often benign villous adenoma. It was first reported in 1954 by McKittrick and Wheelock. Patients present with chronic diarrhea, severe hyponatremia, hypokalemia, and/or acute kidney injury. This work consists of an elaborate bibliographic review, in order to elucidate what is known about this pathology classified as rare. It aims to improve the diagnosis and management of this potentially lethal syndrome and to understand its presentation and pathophysiology, in order to allow the physician to anticipate the patient's deterioration. Pathophysiologically, there is hypersecretion of prostaglandin E2 in secretory tubulovillous adenomas. However, it remains an uncommon and poorly recognized disease, presenting significant morbidity if not properly treated. Due to the long period between the onset of symptoms and diagnosis, therapy ends up being delayed. Definitive treatment, which often proves to be curative, must be performed after the patient has stabilized, by means of tumor resection. After fluid and electrolyte replacement and early definitive surgery, the prognosis tends to be good.

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“…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%

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 (Electrolyte Depletion Syndrome)

Cited by 3 publications

References 1 publication

Endoscopic Submucosal Dissection of a Giant Rectal Adenoma Manifesting as McKittrick-Wheelock Syndrome

Endoscopic Submucosal Dissection of a Giant Rectal Adenoma Manifesting as McKittrick-Wheelock Syndrome

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

McKittrick-Wheelock Syndrome Secondary to Rectal Adenocarcinoma

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