McKittrick-Wheelock Syndrome Research Articles

Giant villous adenoma and McKittrick–Wheelock syndrome in an incarcerated rectal prolapse

Colorectal DiseaseVolume 12, Issue 4 p. 382-384 Giant villous adenoma and McKittrick–Wheelock syndrome in an incarcerated rectal prolapse I.N. Galanis, I.N. Galanis “G.Gennimatas” District Hospital, 2nd Surgical Clinic, Aristotle University of Thessaloniki, Ethnikis Aminis, 41, Thessaloniki, GreeceSearch for more papers by this authorD.M. Dragoumis, D.M. Dragoumis “G.Gennimatas” District Hospital, 2nd Surgical Clinic, Aristotle University of Thessaloniki, Ethnikis Aminis, 41, Thessaloniki, GreeceSearch for more papers by this authorP.N. Christopoulos, P.N. Christopoulos “G.Gennimatas” District Hospital, 2nd Surgical Clinic, Aristotle University of Thessaloniki, Ethnikis Aminis, 41, Thessaloniki, GreeceSearch for more papers by this authorN.N. Galanis, N.N. Galanis “G.Gennimatas” District Hospital, 2nd Surgical Clinic, Aristotle University of Thessaloniki, Ethnikis Aminis, 41, Thessaloniki, GreeceSearch for more papers by this authorK.S. Atmatzidis, K.S. Atmatzidis “G.Gennimatas” District Hospital, 2nd Surgical Clinic, Aristotle University of Thessaloniki, Ethnikis Aminis, 41, Thessaloniki, GreeceSearch for more papers by this author I.N. Galanis, I.N. Galanis “G.Gennimatas” District Hospital, 2nd Surgical Clinic, Aristotle University of Thessaloniki, Ethnikis Aminis, 41, Thessaloniki, GreeceSearch for more papers by this authorD.M. Dragoumis, D.M. Dragoumis “G.Gennimatas” District Hospital, 2nd Surgical Clinic, Aristotle University of Thessaloniki, Ethnikis Aminis, 41, Thessaloniki, GreeceSearch for more papers by this authorP.N. Christopoulos, P.N. Christopoulos “G.Gennimatas” District Hospital, 2nd Surgical Clinic, Aristotle University of Thessaloniki, Ethnikis Aminis, 41, Thessaloniki, GreeceSearch for more papers by this authorN.N. Galanis, N.N. Galanis “G.Gennimatas” District Hospital, 2nd Surgical Clinic, Aristotle University of Thessaloniki, Ethnikis Aminis, 41, Thessaloniki, GreeceSearch for more papers by this authorK.S. Atmatzidis, K.S. Atmatzidis “G.Gennimatas” District Hospital, 2nd Surgical Clinic, Aristotle University of Thessaloniki, Ethnikis Aminis, 41, Thessaloniki, GreeceSearch for more papers by this author First published: 11 March 2010 https://doi.org/10.1111/j.1463-1318.2009.01809.xCitations: 4 Ioannis Galanis, Senior Lecturer of Surgery, Thermaikou 45, 55 133, Thessaloniki, Greece.E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume12, Issue4April 2010Pages 382-384 RelatedInformation

Giant secretory villous adenoma of the rectum and sigmoid presenting as McKittrick–Wheelock syndrome

Giant secretory villous adenoma of the rectum and sigmoid presenting as McKittrick–Wheelock syndrome

Giant villous adenoma presenting as McKittrick–Wheelock syndrome and pseudo‐obstruction

McKittrick-Wheelock syndrome is a rare but recognised complication of hypersecretory rectosigmoid villous adenoma. Fluid and electrolyte imbalances require close monitoring because of large-volume losses of water, sodium and potassium. We report an unusual presentation of the syndrome associated with the development of acute pseudo-obstruction of the colon, presumably due to electrolyte dysfunction and acute renal failure.

McKittrick-Wheelock Syndrome: A Rare Cause of Life-Threatening Electrolyte Disturbances and Volume Depletion

Background: It is uncommon for emergency physicians to discover a patient with circulatory failure resulting from chronic diarrhea. Objectives: We describe McKittrick-Wheelock syndrome, a rare disorder characterized by volume and electrolyte depletion and caused by colonic neoplasm. Case Report: The case of a 30-year-old woman who came to the Emergency Department with hypovolemic shock, hyponatremia, and hypokalemia with a background of chronic diarrhea is reported. The hypokalemia and dehydration were refractory to aggressive replacement therapy. Her condition was the result of fluid and electrolyte hypersecretion caused by a colonic adenocarcinoma and colonic polyposis. Surgical removal of the colon and subsequent volume and electrolyte replacement therapy resulted in complete recovery. Conclusion: This case is presented to increase awareness among emergency physicians of the rare disorder of McKittrick-Wheelock syndrome.

McKittrick-Wheelock Syndrome Treated by Laparoscopy

To present 3 cases of secreting villous adenoma (McKittrick-Wheelock syndrome) successfully treated with laparoscopic surgery. We present 3 cases, characterized by chronic diarrhea and requiring hospitalization owing to electrolyte and fluid depletion with acute renal failure. Owing to the extension and location of the adenomas, laparoscopic surgery (low anterior resection or procto-sigmoidectomy resection) was performed after medical treatment and endoscopic diagnosis. Postoperative recovery was satisfactory. When colonoscopic resection is not feasible in cases of secreting villous adenomas owing to their size or location, laparoscopic surgery in expert hands is a safe, effective, and complete option, further enhanced by the benefits of minimally invasion surgery.

Villous Rectal Adenoma as a Rare Cause of Acute Renal Failure (McKittrick-Wheelock Syndrome)

Fluid and electrolyte hypersecretion in a villous adenoma of the rectum was seen in a 72-year-old male suffering from acute renal failure. The patient was found to have prerenal uremia on admission, and received emergency hemodialysis. He then underwent systemic screenings for other possible diseases because of his severe emaciation. A barium enema examination revealed a large villous lesion of the upper rectum. Operative local excision of the tumor was performed. Renal function was restored after radical tumor surgery. McKittrick-Wheelock syndrome could be managed successfully by acute hemodialysis and early surgical resection of rectal tumor.

The McKittrick-Wheelock Syndrome: A Case of Acute Renal Failure Due to Neoplastic Cholera

The McKittrick Wheelock syndrome is characterized by severe electrolyte and fluid depletion as a result of rectal tumor hypersecretion. Typically, a metabolic acidosis ensues. We report the case of a 58-year-old man who presented with a mixed metabolic acidosis and alkalosis. He was hyponatremic, hypokalemic, and hypochloremic, with acute renal failure on blood testing. Following fluid resuscitation, a predominant alkalemia was observed. The patient was found to be passing 1.5 L of mucous per rectum per day, containing high concentrations of sodium and potassium, similar to that observed in cholera stool. A large rectal villous adenoma was discovered on sigmoidoscopy, and definitive management was achieved by removal of the tumor. This case provides a demonstration of the ranging metabolic disturbance associated with secretory diarrhea. Other endogenous and infective causes are discussed, and mechanisms compared with the case described.

McKittrick-Wheelock syndrome: a cause of severe hydro-electrolyte disorders in ED

McKittrick-Wheelock syndrome: a cause of severe hydro-electrolyte disorders in ED

Giant Villous Adenoma and the McKittrick-Wheelock Syndrome

Introduction: McKittrick-Wheelock syndrome is a rare condition characterized by a rectal villous adenoma causing dehydration from diarrhea with severe hyponatremia, hypokalemia, metabolic acidosis, and acute renal failure. Case: A 63 year-old male with multiple admissions for hyponatremia was admitted with obtundation and dehydration. Labs showed Na+ = 100 mEq/L, K+ = 5.2 mEq/L, creatinine = 5.0 mg/dL, urine Na+ = 10 mmol/L. He was resuscitated with normal saline, but over 10 days, developed status epilepticus and abdominal distension. An abdominal CT depicted colonic distension and a rectosigmoid mass. (Fig A) Colonoscopy found 2.5L of thick mucoid fluid in the rectum, and underneath, a circumferential mass measuring 13cm long. Biopsies of the lesion revealed villous adenoma without dysplasia. (Fig. B) Analysis of the rectal fluid showed Na+ = 151 mEq/L, K+ = 11.7 mEq/L, and Cl− = 133 mEq/L, suggesting a secretory diarrhea. Indomethacin (25 mg PO TID) was given to decrease rectal effluent and help maintain electrolytes. Discussion: McKittrick-Wheelock syndrome is a rare cause of hyponatremia. The diarrhea is secretory with stool Na+ being isotonic to serum Na+ and stool K+ being 5–15x higher. The secretagogues cAMP and prostaglandin E2 (PGE2) alter intestinal electrolyte transport. Assays of secretory villous adenoma tissue have found 6x higher cAMP content and 17–38% higher cAMP protein dependent kinase activity. High levels of PGE2 have also been measured in villous adenoma related rectal effluent. Indomethacin is a way to block PGE2 production by inhibiting cyclooxygenase, therby decreasing rectal effluent and normalizing electrolyte imbalance prior to mass resection. McKittrick-Wheelock syndrome should be considered in the differential of recurrent severe hyponatremia. [figure 1][figure 2]Figure 1Figure 2

McKittrick???Wheelock syndrome: a rare cause of diarrhoea

McKittrick-Wheelock syndrome is a rare disorder caused by fluid and electrolyte hypersecretion from a rectal tumour. The most frequently reported tumours are villous adenomas. Dehydration with severe hyponatremia, hypokalemia, metabolic acidosis, acute renal failure and watery diarrhoea is typical. The authors present a case of McKittrick-Wheelock syndrome caused by rectal adenocarcinoma.