The Mckittrick-Wheelock Syndrome: A Rare Cause of Severe Hydroelectrolyte Disorders and Acute Renal Failure

Abstract

The McKittrick-Wheelock syndrome is a rare cause of severe hydroelectrolyte disorders and fluid depletion as a result of rectal tumor hypersecretion, which can lead to acute renal failure. We report the case of a 70-year-old female who presented with hyponatremia, hypokalemia, hypochloremia, and acute renal failure, due to a watery, mucinous diarrhea. A large rectal villous adenoma was discovered on ileocolonoscopy, and definitive management was achieved by removal of the tumor. In conclusion, reversal of the biochemical derangement is the cornerstone of successful management of the McKittrick-Wheelock syndrome. Then, immediate surgical resection of the tumor is the treatment of choice.

The McKittrick-Wheelock syndrome: A rare case with a complex acid-base disorder

“…2,9,10 Despite many authors suggest a strict dichotomy between secretory and non-secretory villous adenomas 2 some evidences support the hypothesis of a secretory continuum, making cases of MWS the extreme end. 11 The result of losses can reach to 1.5-3.5 L of fluid/day with large amount of electrolyte, 12 leading some author to use the expression neoplastic cholera. 13 Characteristically in early stages these losses can be compensated by renal adaptation and oral intake, but as tumor size increases compensatory mechanisms become exhausted.…”

“…To our knowledge only a few cases with MWS and metabolic alkalosis have been reported. 18,19 Moreover most of authors have focused on electrolyte disorders 3,8,12,15 giving less importance to the acid-base imbalance. MWS syndrome is a rare condition that may develop life-threatening complications, but if promptly diagnosed and treated is completely reversible.…”

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

“…Other presentations seen in the literature include:14 16 acute kidney injury, syncope, hypovolaemic shock, weakness, dermatomyositis, rectal prolapse or rectal intussusception. Regardless of the initial presentation, all patients exhibit massive fluid losses, up to 1.5–3.5 L per day, and the losses will increase as the adenoma grows 12 17. The secreted fluid is rich in sodium, potassium and chloride depleting these electrolytes in a very acute and severe manner.…”

A case report of a giant rectal adenoma causing secretory diarrhea and acute renal failure: McKittrick-Wheelock syndrome

“…Complete removal of the lesion prevents progression of the tumoral disease and resolves the depletion syndrome [ 4 , 6 , 7 ]. In addition, some authors have reported successful outcomes obtained with laparoscopic rectal resections and intersphincteric rectal resections [ 13 , 14 ].…”