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Kouladouros K, Schneider K, Kubicka S, Hoerner C, Hirth M. Endoscopic Submucosal Dissection of a Giant Rectal Adenoma Manifesting as McKittrick-Wheelock Syndrome. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:944-951. [PMID: 37751770 DOI: 10.1055/a-2163-5913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
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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Affiliation(s)
- Konstantinos Kouladouros
- Central Interdisciplinary Endoscopy Department, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Klaus Schneider
- Medizinische Klinik 1, Klinikum am Steinenberg, Reutlingen, Germany
| | - Stefan Kubicka
- Medizinische Klinik 1, Klinikum am Steinenberg, Reutlingen, Germany
| | - Christian Hoerner
- Institute of Pathology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Hirth
- Department of Medicine II, University Medical Centre Mannheim, Mannheim, Germany
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Marcinkevičiūtė K, Kryžauskas M, Poškus T. McKittrick-Wheelock Syndrome: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59030633. [PMID: 36984634 PMCID: PMC10056017 DOI: 10.3390/medicina59030633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
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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Affiliation(s)
| | - Marius Kryžauskas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Tomas Poškus
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
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Villanueva MEP, Onglao MAS, Tampo MMT, Lopez MPJ. McKittrick-Wheelock Syndrome: A Case Series. Ann Coloproctol 2021; 38:266-270. [PMID: 34256428 PMCID: PMC9263311 DOI: 10.3393/ac.2020.00745.0106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/15/2021] [Indexed: 11/18/2022] Open
Abstract
McKittrick-Wheelock syndrome is a rare and life-threatening disease characterized by the triad of (1) chronic mucous diarrhea, (2) renal function impairment with hydroelectrolyte imbalance, and (3) a giant colorectal tumor. Often, the tumor is a rectal adenoma. With the mortality being certain, if left untreated, it is important to raise awareness on the presentation, diagnosis, and management of this disease entity. Here, we presented 3 cases of McKittrick-Wheelock syndrome that were successfully managed with surgical resection at the Philippine General Hospital from August 2018 to May 2019. Resolution of their symptoms, reversal of their renal impairment, and correction of their electrolyte depletion were noted after removal of the tumor with a sphincter-saving operation.
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Affiliation(s)
- Maureen Elvira P Villanueva
- Division of Colorectal Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Mark Augustine S Onglao
- Division of Colorectal Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Mayou Martin T Tampo
- Division of Colorectal Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Marc Paul J Lopez
- Division of Colorectal Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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van der Pool AEM, de Graaf EJR, Vermaas M, Barendse RM, Doornebosch PG. McKittrick Wheelock Syndrome Treated by Transanal Minimally Invasive Surgery: A Single-Center Experience and Review of the Literature. J Laparoendosc Adv Surg Tech A 2017; 28:204-208. [PMID: 28657837 DOI: 10.1089/lap.2017.0195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION McKittrick Wheelock Syndrome (MKWS) is a rare syndrome characterized by secretory diarrhea, dehydration, prerenal acute kidney injury, and severe electrolyte abnormalities caused by a large hypersecretory villous adenoma located in the rectum or rectosigmoid junction. Transabdominal (laparoscopic) procedures are the most described procedures in the treatment of MKWS. We report an alternative surgical approach, transanal minimally invasive surgery (TAMIS), to solve this syndrome. MATERIALS AND METHODS All patients who underwent transanal endoscopic microsurgery or TAMIS were included in a prospectively collected database in our center. Between 1996 and 2015, 3 patients were found to have MKWS and treated by TAMIS. Demographics, characteristics of the adenoma, surgery-related data, and outcome were analyzed. RESULTS The first patient had a villous adenoma 0-12 cm from the anal verge. After TAMIS, she complained of a stenosis that was successfully treated by dilatation. The second patient had an impressive bulky tumor in the rectum. An endoscopic mucosal resection was attempted twice, but incompletely. Pathology analysis showed villous adenoma with high-grade dysplasia and intramucosal carcinoma. One year after TAMIS, a recurrence was detected and treated by an abdominal-perineal resection. A TAMIS was performed in the third patient because of a giant villous circular adenoma, but because of high mucus and fluid production, no proper overview could be obtained. Together with opening of the peritoneum, this prompted us to convert to a laparoscopic Hartmann procedure. Besides this technical difficulty, the patient recovered uneventful. CONCLUSIONS MKWS is a rare syndrome and missed diagnosis could result in life-threatening situations. Different endoscopic and surgical treatments are described to solve this syndrome. TAMIS should be considered as a rectum-preserving surgical treatment option for such extensive adenomas.
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Affiliation(s)
| | | | - Maarten Vermaas
- 1 Department of Surgery, IJsselland Hospital , Capelle Ad IJssel, The Netherlands
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López Pardo P, Jiménez Rojas C, Castro Cristóbal C, Díaz Vila A. McKittrick-Wheelock syndrome in centenarian patient. Conservative treatment. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2016.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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ElGuindy YM, Javadi S, Menias CO, Jensen CT, Elsamaloty H, Elsayes KM. Imaging of secretory tumors of the gastrointestinal tract. Abdom Radiol (NY) 2017; 42:1113-1131. [PMID: 27878636 DOI: 10.1007/s00261-016-0976-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Gastrointestinal secretory tumors, or gastroenteropancreatic neuroendocrine tumors, encompass a wide array of endocrine cell tumors. The significance of these tumors lies in their ability to alter physiology through hormone production as we well as in their malignant potential. Functioning tumors may present earlier due to symptomatology; conversely, non-functioning tumors are often diagnosed late as they reach large sizes, causing symptoms secondary to local mass effect. Imaging aids in the diagnosis, staging, and prognosis and provides key information for presurgical planning. Although most of these tumors are sporadic, some are associated with important syndromes and associations, knowledge of which is critical for patient management. In this article, we provide an overview of secretory and neuroendocrine tumors of the GI tract and pancreas.
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Kagan MD, Schmidt K, Sangha G. Indomethacin therapy effective in a patient with depletion syndrome from secretory villous adenoma. BMJ Case Rep 2017; 2017:bcr-2016-217211. [PMID: 28188165 DOI: 10.1136/bcr-2016-217211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This paper details the case of a 26-year-old woman with depletion syndrome and the effectiveness of her treatment with indomethacin. Villous adenomas are benign neoplasms with a high incidence of becoming malignant. A small percentage of villous adenomas are known to cause depletion syndrome, also referred to as the McKittrick-Wheelock syndrome, a condition characterised by secretory diarrhoea, dehydration, hyponatremia, hypokalaemia, hypochloraemia, metabolic acidosis and acute renal failure. Prostaglandin-E2 mediates the hypersecretion mechanism observed in depletion syndrome, and can be inhibited by cyclo-oxygenase inhibitors. This case study measured the effectiveness of prostaglandin inhibition on a patient with oral and parenteral electrolyte replacement refractory depletion syndrome. Fluid loss and prostaglandin levels were measured before and after pharmacological treatment. This case demonstrates a 49% decrease in rectal effluent and a marked commensurate decrease in daily replenishment requirements within 48 hours of indomethacin treatment initiation, resulting in subsequent electrolyte stabilisation.
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Affiliation(s)
| | - Kara Schmidt
- Department of Internal Medicine, University of California San Francisco Fresno Center for Medical Education and Research, Fresno, California, USA
| | - Gurtej Sangha
- Ross University School of Medicine, North Brunswick, New Jersey, USA
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The Case | Acute renal failure and refractory hyponatremia. Kidney Int 2016; 90:713-4. [PMID: 27521124 DOI: 10.1016/j.kint.2016.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/25/2016] [Accepted: 02/04/2016] [Indexed: 11/20/2022]
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Malik S, Mallick B, Makkar K, Kumar V, Sharma V, Rana SS. Malignant McKittrick-Wheelock syndrome as a cause of acute kidney injury and hypokalemia: Report of a case and review of literature. Intractable Rare Dis Res 2016; 5:218-21. [PMID: 27672546 PMCID: PMC4995412 DOI: 10.5582/irdr.2016.01011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Colonic polyps are usually asymptomatic, and are commonly detected during screening colonoscopy. Severe hypokalemia secondary to secretory diarrhea is a rare presentation of rectal polyps. We present a 70 years old female with hypokalemia and acute kidney injury secondary to secretory diarhea due to moderately differentiated adenocarcinoma of rectum, all of which is syndromically sometimes referred to as McKittrick and Wheelock syndrome. The case is presented because McKittrick-Wheelock syndrome is still more uncommon with malignancy. The syndrome may be associated with other features of hypersecretory diarrhea. Though very rare, clinical suspicion would often lead to diagnosis and appropriate management. We also review the previously published reports of this entity.
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Affiliation(s)
- Sarthak Malik
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bipadabhanjan Mallick
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kunaal Makkar
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Address correspondence to: Dr. Vishal Sharma, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
| | - Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ohara Y, Toyonaga T, Watanabe D, Hoshi N, Adachi S, Yoshizaki T, Kawara F, Tanaka S, Ishida T, Okuno T, Ikehara N, Morita Y, Umegaki E, Yokozaki H, Azuma T. Electrolyte depletion syndrome (McKittrick-Wheelock syndrome) successfully treated by endoscopic submucosal dissection. Clin J Gastroenterol 2015; 8:280-4. [PMID: 26304954 DOI: 10.1007/s12328-015-0597-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/28/2015] [Indexed: 12/28/2022]
Abstract
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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Affiliation(s)
- Yoshiko Ohara
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | | | - Daisuke Watanabe
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Namiko Hoshi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Soichiro Adachi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tetsuya Yoshizaki
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Fumiaki Kawara
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinwa Tanaka
- Department of Endoscopy, Kobe University Hospital, Kobe, Japan
| | - Tsukasa Ishida
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuya Okuno
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobunao Ikehara
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshinori Morita
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eiji Umegaki
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Yokozaki
- Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Azuma
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Affiliation(s)
- Michael J Raphael
- Institute of Health Policy Management and Evaluation (Detsky), University of Toronto; Department of Medicine (Raphael, McDonald, Detsky), University of Toronto; Departments of Medicine (Raphael, McDonald, Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont
| | - Christine M McDonald
- Institute of Health Policy Management and Evaluation (Detsky), University of Toronto; Department of Medicine (Raphael, McDonald, Detsky), University of Toronto; Departments of Medicine (Raphael, McDonald, Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont
| | - Allan S Detsky
- Institute of Health Policy Management and Evaluation (Detsky), University of Toronto; Department of Medicine (Raphael, McDonald, Detsky), University of Toronto; Departments of Medicine (Raphael, McDonald, Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.
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Maeshiro Y, Yamaji Y, Inoue S, Nakazato Y. Prerenal uremia induced by severe diarrhea due to colon adenoma: a case of McKittrick-Wheelock syndrome in an elderly patient. CEN Case Rep 2014; 3:75-79. [PMID: 28509250 PMCID: PMC5411540 DOI: 10.1007/s13730-013-0089-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 07/05/2013] [Indexed: 12/21/2022] Open
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 μmol/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 μmol/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 near-circumferential 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 μmol/L.
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Affiliation(s)
- Yuri Maeshiro
- Internal Medicine, Saitama Social Insurance Hospital, 4-9-3 Kitaurawa, Urawa-ku, Saitama-City, Saitama, 330-0074, Japan.
| | - Yasuyoshi Yamaji
- Kidney Disease Center and Internal Medicine, Saitama Social Insurance Hospital, 4-9-3 Kitaurawa, Urawa-ku, Saitama-City, Saitama, 330-0074, Japan
| | - Shuji Inoue
- Kidney Disease Center and Internal Medicine, Saitama Social Insurance Hospital, 4-9-3 Kitaurawa, Urawa-ku, Saitama-City, Saitama, 330-0074, Japan
| | - Yuichi Nakazato
- Kidney Disease Center and Internal Medicine, Saitama Social Insurance Hospital, 4-9-3 Kitaurawa, Urawa-ku, Saitama-City, Saitama, 330-0074, Japan
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Kapoor S. Mckittrick-Wheelock syndrome: an often, overlooked complication of rectal adenomas. Surg Endosc 2014; 28:2247. [PMID: 24671351 DOI: 10.1007/s00464-014-3462-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 12/27/2013] [Indexed: 11/29/2022]
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Abstract
Metabolic alkalosis is a common disorder, accounting for half of all acid-base disturbances in hospitalized patients. It is the result of an increase in bicarbonate production, a decrease in bicarbonate excretion, or a loss of hydrogen ions. Most causes of metabolic alkalosis can be divided into 4 categories: chloride depletion alkalosis, mineralocorticoid excess syndromes, apparent mineralocorticoid excess syndromes, and excess alkali administration. Treatment is usually supportive and based on cause of the alkalosis.
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Affiliation(s)
- Jennifer T Soifer
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 North State Street, Los Angeles, CA 90033, USA.
| | - Hyung T Kim
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 North State Street, Los Angeles, CA 90033, USA
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Choi WH, Ryuk J, Kim HJ, Park SY, Park JS, Kim JG, Choi GS. A case of giant rectal villous tumor with severe fluid-electrolyte imbalance treated by laparoscopic low anterior resection. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:325-9. [PMID: 22563542 PMCID: PMC3341484 DOI: 10.4174/jkss.2012.82.5.325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 12/06/2011] [Accepted: 12/16/2011] [Indexed: 11/30/2022]
Abstract
McKittrick-Wheelock syndrome is a disorder caused by fluid and electrolyte hypersecretion from a colorectal tumor. To present the case of a patient with a giant rectal villous tumor with McKittrick-Wheelock syndrome who was successfully treated with laparoscopic surgery. The case of a 59-year-old man who came to the emergency department with syncope, prerenal azotemia, and electrolyte disturbances with a background of chronic diarrhea is reported. His condition was the result of fluid and electrolyte hypersecretion caused by rectal villotubular adenomas. Laparoscopic low anterior resection and subsequent volume and electrolyte replacement therapy resulted in complete recovery. A microscopic examination revealed multiple, well-differentiated adenocarcinomas arising in villotubular adenomas. Laparoscopic surgical resection is a feasible therapeutic modality for McKittrick-Wheelock syndrome.
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Affiliation(s)
- Won Ho Choi
- Colorectal Cancer Center, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea
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The mckittrick-wheelock syndrome: a rare cause of severe hydroelectrolyte disorders and acute renal failure. Case Rep Nephrol 2011; 2011:765689. [PMID: 24533197 PMCID: PMC3914135 DOI: 10.1155/2011/765689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 08/08/2011] [Indexed: 12/02/2022] Open
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.
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