Prerenal uremia induced by severe diarrhea due to colon adenoma: a case of McKittrick–Wheelock syndrome in an elderly patient

Abstract

McKittrick-Wheelock syndrome can be successfully treated by emergent dialysis, prescription of bicarbonate, and endoscopic submucosal dissection, which allow elderly people suffering from this syndrome to maintain their activities of daily living. In patients with this syndrome, a large colonic villous adenoma secretes excessive amounts of mucus and causes severe electrolyte depletion and dehydration. An 81-year-old man who had been suffering from chronic renal failure (creatinine 256.4 lmol/L), hypertension, and arrhythmia presented with frequent mucous diarrhea for a month. He was hospitalized for appetite loss, vomiting, general fatigue, and acute renal failure. His blood tests and blood gas analysis revealed urea nitrogen 58.9 mmol/L, creatinine 954.7 lmol/L, pH 7.13, and a base excess of -20.1 mmol/L. Although his symptoms were improved by the emergent dialysis and rehydration, he suffered a relapse only 4 days after he was discharged. At the second admission, a nearcircumferential tumor was found in the rectum by the colonoscopy, which was pathologically confirmed as a villous adenoma. Considering his age and complications, endoscopic submucosal dissection was selected, and internal use of sodium bicarbonate was prescribed. Diarrhea and appetite loss were improved by these treatments, and the creatinine level was also improved to 168.0 lmol/L.

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

“…Our literature review revealed three cases of similar lesions treated through ESD, all of which were performed in Japanese centers. However, to our knowledge, this is the first report of such a rectal adenoma manifesting with MKWS treated through ESD outside of Japan [6,39,40]. From the three previously reported cases, one tumor was resected in a single procedure, like in our case, while the other two required two and three subsequent procedures, respectively, to achieve a complete resection.…”

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

“…The decrease in volume also culminates in secondary hyperaldosteronism, increasing alkalosis and hypokalemia. 3,16 Therefore, associated with dehydration and mucous diarrhea, the main findings are hyponatremia and hypokalemia. The first encompasses symptoms such as headache, nausea, lethargy, muscle cramps, weakness and seizures.…”