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      McKittrick-Wheelock Syndrome Presenting with Acute Kidney Injury and Metabolic Alkalosis: Case Report and Narrative Review

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          Abstract

          A rare combination of severe volume depletion and electrolyte imbalance caused by a rectal villous adenoma is often referred to as the McKittrick-Wheelock syndrome. Patients usually seek medical care because of chronic hypersecretory diarrhea and display renal failure, metabolic acidosis, hyponatremia, and hypokalemia. We report the case of a 68-year-old woman who presented with this condition but showed unusual features such as severe hypokalemia and metabolic alkalosis, without diarrhea. She subsequently underwent transanal endoscopic microsurgery (TEMS), an innovative procedure in the management of large rectal adenomas. We also provide a narrative review of the literature on this rare entity.

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          Most cited references23

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          Metabolic alkalosis.

          T J Galla (2000)
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            Carcinoma of the colon. 1954.

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              Prostaglandin E2-mediated secretory diarrhea in villous adenoma of rectum: effect of treatment with indomethacin.

              Biochemical and clinical evidence is presented to indicate that prostaglandin (PG)E2 is the mediator of fluid and electrolyte secretion by villous adenomas of the rectum. A 64-yr-old man with a 2-mo history of mucous diarrhea had, on admission, prerenal uremia, severe hyponatremia, and hypokalemia. At sigmoidoscopy an 11 X 11-cm villous adenoma of the rectum was revealed. The rectal fluid discharge was 1800-1825 ml/day, with sodium and potassium concentrations of 150 and 12 mEq/L, respectively. Immunoreactive PGE2 levels in the rectal effluents were high (viz. 1160-1250 pg/ml vs. 200-395 pg/ml) compared with those in stool water from patients with infectious diarrhea. The concentration of vasoactive intestinal polypeptide (VIP) in the tumor was lower (viz. 10.5 pmol/g vs. 100-700 pmol/g) than in normal colonic mucosa. Indomethacin treatment (24 mg X 4 daily) reduced the rectal PGE2 excretion from 2.2 to 0.3 microgram/day and caused a decrease in the rectal fluid loss of 850 ml/day associated with a similar reduction in rectal sodium excretion. Discontinuing medication, a rise in the rectal excretions of PGE2, fluid, and sodium was observed. In conclusion, PGE2 formation in the villous adenoma appears to be the cause of fluid secretion by the abnormal tumor epithelium. The use of PG synthetase inhibitors may facilitate the preoperative correction of severe fluid-electrolyte deficits in patients with large villous adenomas of the rectum.
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                Author and article information

                Contributors
                Journal
                Case Rep Gastrointest Med
                Case Rep Gastrointest Med
                CRIGM
                Case Reports in Gastrointestinal Medicine
                Hindawi
                2090-6528
                2090-6536
                2019
                31 January 2019
                : 2019
                : 3104187
                Affiliations
                1Faculty of Medicine, Laval University, Québec City, QC, Canada
                2Department of Internal Medicine, CHU de Québec, Québec City, QC, Canada
                3Department of Surgery, CHU de Québec, Québec City, QC, Canada
                4Department of Gastroenterology, CHU de Québec, Québec City, QC, Canada
                5Faculty of Medicine, Department of Medicine, Laval University, Québec City, QC, Canada
                Author notes

                Academic Editor: Chia-Tung Shun

                Author information
                http://orcid.org/0000-0002-3197-9704
                Article
                10.1155/2019/3104187
                6374786
                5781f3c7-ca9a-4608-8a3c-6de1d6c0d0f3
                Copyright © 2019 Mireille Caron et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 October 2018
                : 9 January 2019
                Categories
                Case Report

                Gastroenterology & Hepatology
                Gastroenterology & Hepatology

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