McKittrick-Wheelock Syndrome Secondary to Rectal Adenocarcinoma

• Published in: Journal of Coloproctology Vol. 42; no. 2; pp. 187 - 189
• Main Authors: Martins, Bruno Augusto Alves, Gomes, Ana Clara Ramalho, Santos, Maria Eduarda de Almeida, Moreira, Natascha Mourão, Almeida, Romulo Medeiros de, Sousa, João Batista de
• Format: Journal Article
• Language: English
• Published: Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil Thieme Revinter Publicações Ltda 01-06-2022
• Subjects: acute kidney injury; Case Report; chronic diarrhea; colorectal neoplasms; colorectal surgery; electrolyte disturbance; syndromes; colorectal surgery; electrolyte disturbance; syndromes; acute kidney injury; colorectal neoplasms; chronic diarrhea
• ISSN: 2237-9363; 2317-6423
• DOI: 10.1055/s-0041-1742255

Abstract
Introduction
 McKittrick-Wheelock syndrome is a rare condition that arises from a hypersecretory state secondary to large colorectal tumors, mainly villous adenomas, leading to an electrolytic disorder associated with chronic diarrhea that usually persists for years. It is a relatively unknown disease that can lead to severe complications such as acute kidney injury, severe hyponatremia, and hypokalemia. In fact, it causes death in most untreated cases. Surgical removal of the tumor is the most successful treatment, and symptoms tend to disappear after proper management.
Case Report
 A 62-year-old man with a 2-year history of mucoid diarrhea preceded by abdominal pain presented with acute kidney injury, hyponatremia, and hypokalemia. A digital rectal examination and sigmoidoscopy were performed, and revealed a large laterally-spreading tumor in the rectum. Further investigation showed a rectal tubulovillous adenoma with secondary McKittrick-Wheelock syndrome. An anterior resection of the rectum with a colonic J-pouch and a diverting ileostomy were performed, and the patient improved with the resolution of the renal failure and electrolyte disturbances. The histopathological analysis revealed an invasive rectal adenocarcinoma.
Discussion
 McKittrick-Wheelock syndrome is a condition with a low incidence that needs early intervention and proper diagnosis. It is of extreme importance that this disease is included in the differential diagnoses for chronic diarrhea associated with an electrolytic disorder.