LETTERS TO THE EDITOR

 

McKittrick-Wheelock syndrome: unusual, but potentially lethal

Síndrome McKittrick-Wheelock: raro, pero potencialmente letal

 

 

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Key words: McKittrick-Wheelock. Villous.

Palabras clave: McKittrick-Wheelock. Velloso.

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Dear Editor,

The McKittrick-Wheelock syndrome (1) is characterized by extracellular volume depletion and severe electrolyte imbalance caused by hyper-secreting rectal tumors, usually villous adenomas (2).

 

Case report

We report the case of a 70-year-old man who presented to the Emergency Department with watery diarrhea and mucus discharge of five weeks duration with more than six bowel movements per day. The patient showed signs of dehydration and severe hydroelectrolytic disturbances, although he was hemo-dynamically stable and showed no disturbances in levels of consciousness. The following analytical parameters were observed: urea 228 mg/dl, creatinine 1.8 mg/dl, sodium 120 mEq/l, potassium 2.5 mEq/l and chlorine 83 mEq/l.

After volume and electrolyte replacement, a colonoscopy was performed which identified a large rectal polyp. Biopsy samples were compatible with villous adenoma. Since the tumor was not removable by endoscopy, the patient underwent an abdomino-perineal amputation with terminal colostomy.

 

Discussion

McKittrick-Wheelock syndrome was first described in 1954 (1). Its symptomatology includes secretory diarrhea with volume depletion and several electrolytic imbalances in association with large rectal villous adenomas (2,3). The treatment of choice after ionic correction is surgical removal, although cases of endoscopic treatment and radiotherapy have been described (4). In this case, the prognosis was excellent. However, if the cause is not eliminated the mortality rate is 100%. For this reason, a fast and accurate diagnosis is essential.

 

María López-Álvarez¹, Jesús Ángel Yáñez-López¹ and Aldara Naveiras-Calvo²
Departments of ¹Digestive Diseases and ²Internal Medicine.
Complexo Hospitalario Universitario A Coruña. A Coruña, Spain

 

References

1. McKittrick LS, Wheelock FC. Carcinoma of the colon. 1954. Dis Colon Rectum 1997. DOI: 10.1007/BF02070718.         [ Links ]

2. Bruno A, Chimienti D, Montanaro A, et al. The McKittrick-Wheelock syndrome: A rare cause of severe hydroelectrolyte disorders and acute renal failure. Case Rep Nephrol 2011:765689. DOI: 10.1155/ 2011/765689.         [ Links ]

3. Watari J, Sakurai J, Morita T, et al. A case of Cronkhite-Canada syndrome complicated by McKittrick-Wheelock syndrome associated with advanced villous adenocarcinoma. Gastrointest Endosc 2011;73(3):624-6. DOI: 10.1016/j.gie.2010.07.024.         [ Links ]

4. Ohara Y, Toyonaga T, Watanabe D, et al. Electrolyte depletion syndrome (McKittrick-Wheelock syndrome) successfully treated by endoscopic submucosal dissection. Clin J Gastroenterol 2015;8(5):280-4. DOI: 10.1007/s12328-015-0597-4.         [ Links ]