A case report of a giant rectal adenoma causing secretory diarrhea and acute renal failure: McKittrick-Wheelock syndrome.
BACKGROUND
The McKittrick-Wheelock syndrome is a rare depletion syndrome caused by a secretory villous adenoma or a carcinoma of the rectosigmoid tract. An aggressive hydroelectrolyte rebalancing is often needed, and curative treatment is obtained only with complete removal of the lesion, by endoscopy or surgery. Low clinical suspicion often delays the diagnosis, resulting in detrimental complications.


METHODS
We report the case of a 75-year-old woman, presenting to the emergency department with acute renal failure and electrolyte imbalance, reporting an history of recurrent episodes of dehydration and chronic diarrhea. After being admitted to the nephrology department she underwent diagnostic investigation that revealed the presence of a giant adenoma of the rectum. The patients received supportive therapy and was subsequently treated with surgery, with a favorable outcome.


CONCLUSIONS
A prompt diagnosis plays an important role in the treatment of McKittrick-Wheelock syndrome. We describe a case of this condition in detail and review the related literature, underlining the typical diagnostic features and exploring the possible therapeutic options.
Division of Surgery, Miulli General Hospital, S.P. 127 Acquaviva-Santeramo km 4, 70021, Acquaviva delle Fonti, Italy. annamaria.agnes@gmail.com.|Catholic University, School of Medicine, Largo Agostino Gemelli n.8, 00168, Rome, Italy. annamaria.agnes@gmail.com.
Annamaria
A
Agnes
Division of Surgery, Miulli General Hospital, S.P. 127 Acquaviva-Santeramo km 4, 70021, Acquaviva delle Fonti, Italy.
Domenico
D
Novelli
Division of Digestive Surgery, Gemelli Hospital, Catholic University, School of Medicine, Largo Agostino Gemelli n.8, 00168, Rome, Italy.
Giovanni Battista
GB
Doglietto
Division of Surgery, Miulli General Hospital, S.P. 127 Acquaviva-Santeramo km 4, 70021, Acquaviva delle Fonti, Italy.|Catholic University, School of Medicine, Largo Agostino Gemelli n.8, 00168, Rome, Italy.
Valerio
V
Papa
D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000601:surgery; D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology*; D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D018253:Adenoma, Villous / Q000150:complications* / Q000175:diagnosis; D000368:Aged; D001706:Biopsy; D003113:Colonoscopy; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D052202:Hydrocolpos / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D017689:Polydactyly / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012004:Rectal Neoplasms / Q000150:complications* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D014591:Uterine Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery
Acute renal failure; Chronic diarrhea; Electrolyte depletion; Secretory polyp; Villous adenoma