J Korean Surg Soc.  2012 May;82(5):325-329.

A case of giant rectal villous tumor with severe fluid-electrolyte imbalance treated by laparoscopic low anterior resection

• Choi WH
• Ryuk J
• Kim HJ
• Park SY
• Park JS
• Kim JG
• Choi GS

Abstract

McKittrick-Wheelock syndrome is a disorder caused by fluid and electrolyte hypersecretion from a colorectal tumor. To present the case of a patient with a giant rectal villous tumor with McKittrick-Wheelock syndrome who was successfully treated with laparoscopic surgery. The case of a 59-year-old man who came to the emergency department with syncope, prerenal azotemia, and electrolyte disturbances with a background of chronic diarrhea is reported. His condition was the result of fluid and electrolyte hypersecretion caused by rectal villotubular adenomas. Laparoscopic low anterior resection and subsequent volume and electrolyte replacement therapy resulted in complete recovery. A microscopic examination revealed multiple, well-differentiated adenocarcinomas arising in villotubular adenomas. Laparoscopic surgical resection is a feasible therapeutic modality for McKittrick-Wheelock syndrome.

Keyword

Diarrhea; Renal insufficiency; Villous adenoma; Laparoscopy

MeSH Terms

Adenocarcinoma
Adenoma
Adenoma, Villous
Azotemia
Colorectal Neoplasms
Diarrhea
Emergencies
Humans
Laparoscopy
Middle Aged
Porphyrins
Renal Insufficiency
Syncope
Porphyrins

Figure

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  Fig. 1 The abdominal computed tomography scan shows massive occupation by a huge villous tumor and diffuse wall thickening at the distal sigmoid colon to rectum.

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  Fig. 2 Colonoscopy revealed multiple polypoid lesions throughout the distal sigmoid colon and rectum.

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  Fig. 3 Macroscopic appearance of multiple polypoid lesions, measuring 25 cm × 12 cm. Most of them were villotubular adenomas. In the central ulcerative area (*), adenocarcinoma with subserosal invasion was confirmed.

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  Fig. 4 Microscopic appearance of the well-differentiated adenocarcinoma arising in a villotubular adenoma (H&E, ×40).

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