Electrolyte depletion syndrome (McKittrick–Wheelock syndrome) successfully treated by endoscopic submucosal dissection

Springer Science and Business Media LLC - Tập 8 - Trang 280-284 - 2015
Yoshiko Ohara1, Takashi Toyonaga2, Daisuke Watanabe1, Namiko Hoshi1, Soichiro Adachi1, Tetsuya Yoshizaki1, Fumiaki Kawara1, Shinwa Tanaka2, Tsukasa Ishida1, Tatsuya Okuno1, Nobunao Ikehara1, Yoshinori Morita1, Eiji Umegaki1, Hiroshi Yokozaki3, Takeshi Azuma1
1Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
2Department of Endoscopy, Kobe University Hospital, Kobe, Japan
3Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan

Tóm tắt

A 66-year-old woman presented to us with malaise, anorexia and rectal mucous discharge, and her laboratory data showed severe hyponatremia, hypokalemia, hypochloremia and renal failure. Computed tomography revealed massive occupation of the rectum by a large tumor. Colonoscopy revealed a mucus-rich villous tumor in the rectum. As there were no other factors that could cause an electrolyte disorder, she was diagnosed with McKittrick–Wheelock syndrome (MWS). The current standard treatment for MWS is partial surgical colectomy. However, surgeries are invasive and postoperative complications sometimes become an issue. After confirming no signs of submucosal invasion of the tumor by magnifying chromoendoscopic examination, endoscopic submucosal dissection (ESD) was indicated. The tumor was completely removed en bloc without adverse events. The histology showed a mucosal adenocarcinoma containing a villous component, 24.5 x 17.0 cm in size. This removal dramatically improved the patient’s symptoms and the electrolyte abnormalities without medication. Although several sessions of endoscopic balloon dilation were required to treat postoperative stricture, she has been symptom-free and had no recurrence for 4 years after treatment. We experienced a case of MWS treated by ESD instead of surgery. ESD should be feasible and beneficial for the treatment of MWS.

Tài liệu tham khảo

McKittrick LS, Wheelock FC. Carcinoma of the colon. Dis Colon Rectum. 1997;40:1494–5 (discussion 1495–1496).

Choi WH, Ryuk J, Kim HJ, et al. A case of giant rectal villous tumor with severe fluid-electrolyte imbalance treated by laparoscopic low anterior resection. J Korean Surg Soc. 2012;82:325–9.

Targarona EM, Hernandez PM, Balague C, et al. McKittrick–Wheelock syndrome treated by laparoscopy: report of 3 cases. Surg Laparosc Endosc Percutan Tech. 2008;18:536–8.

Perera M, Deen K, Wijesuriya S, et al. Sexual and urinary dysfunction following rectal dissection compared with segmental colectomy. Colorectal Dis. 2008;10:689–93.

Kerwel TG, Leichtle SW, Asgeirsson T, et al. Risk factors for readmission after elective colectomy: postoperative complications are more important than patient and operative factors. Dis Colon Rectum. 2014;57:98–104.

Repici A, Hassan C, De Paula Pessoa D, et al. Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review. Endoscopy. 2012;44:137–50.

Toyonaga T, Man IM, Ivanov D, et al. The results and limitations of endoscopic submucosal dissection for colorectal tumors. Acta Chir Iugosl. 2008;55:17–23.

Choi YS, Lee JB, Lee EJ, et al. Can endoscopic submucosal dissection technique be an alternative treatment option for a difficult giant (≥30 mm) pedunculated colorectal polyp? Dis Colon Rectum. 2013;56:660–6.

Ohara Y, Toyonaga T, Tanaka S. Risk of stricture after endoscopic submucosal dissection for large rectal neoplasms. Endoscopy. 2015. [Epub ahead of print].

Pucci G, Rondelli F, Avenia N, et al. Acute renal failure and metabolic alkalosis in a patient with colorectal villous adenoma (McKittrick–Wheelock syndrome). Surgery. 2013;154:643–4.

Nicholson P, Naugler C. McKittrick–Wheelock syndrome may represent the extreme of a normally distributed continuum of secretory activity in colorectal villous adenomas. Clin Chim Acta. 2014;436:9–10.

Dagan A, Reissman P. Giant secretory villous adenoma of the rectum and sigmoid presenting as McKittrick–Wheelock syndrome. Int J Colorectal Dis. 2010;25:909–10.

Tuta LA, Bosoteanu M, Deacu M, et al. McKittrick–Wheelock syndrome: a rare etiology of acute renal failure associated to well-differentiated adenocarcinoma (G1) arising within a villous adenoma. Rom J Morphol Embryol. 2011;52:1153–6.

Steven K, Lange P, Bukhave K, et al. Prostaglandin E2-mediated secretory diarrhea in villous adenoma of rectum: effect of treatment with indomethacin. Gastroenterology. 1981;80:1562–6.

Galanis IN, Dragoumis DM, Christopoulos PN, et al. Giant villous adenoma and McKittrick–Wheelock syndrome in an incarcerated rectal prolapse. Colorectal Dis. 2010;12:382–4.

Kapoor S. Mckittrick–Wheelock syndrome: an often, overlooked complication of rectal adenomas. Surg Endosc. 2014;28:2247.

Bacon HE, Eisenberg SW. Papillary adenoma or villous tumor of the rectum and colon. Ann Surg. 1971;174:1002–8.

Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer. 1975;36:2251–70.

Tierney RP, Ballantyne GH, Modlin IM. The adenoma to carcinoma sequence. Surg Gynecol Obstet. 1990;171:81–94.

Miles LF, Wakeman CJ, Farmer KC. Giant villous adenoma presenting as McKittrick–Wheelock syndrome and pseudo-obstruction. Med J Aust. 2010;192:225–7.

Bartels H. Special aspects of postoperative complications following visceral surgery. Chirurg. 2009;80:780–9.

Kasparek MS, Hassan I, Cima RR, et al. Long-term quality of life and sexual and urinary function after abdominoperineal resection for distal rectal cancer. Dis Colon Rectum. 2012;55:147–54.

Sato H, Inoue H, Kobayashi Y, et al. Control of severe strictures after circumferential endoscopic submucosal dissection for esophageal carcinoma: oral steroid therapy with balloon dilation or balloon dilation alone. Gastrointest Endosc. 2013;78:250–7.

Coda S, Oda I, Gotoda T, et al. Risk factors for cardiac and pyloric stenosis after endoscopic submucosal dissection, and efficacy of endoscopic balloon dilation treatment. Endoscopy. 2009;41:421–6.

Tanaka S, Terasaki M, Kanao H, et al. Current status and future perspectives of endoscopic submucosal dissection for colorectal tumors. Dig Endosc. 2012;24(Suppl 1):73–9.

Kiriyama S, Saito Y, Matsuda T, et al. Comparing endoscopic submucosal dissection with transanal resection for non-invasive rectal tumor: a retrospective study. J Gastroenterol Hepatol. 2011;26:1028–33.

Toyonaga T, Man-i M, East JE, et al. 1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc. 2013;27:1000–8.

Hayashi N, Tanaka S, Nishiyama S, et al. Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors. Gastrointest Endosc. 2014;79:427–35.

Sato K, Ito S, Kitagawa T, et al. Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors. Surg Endosc. 2014;28:2959–65.

Saito Y, Kawano H, Takeuchi Y, et al. Current status of colorectal endoscopic submucosal dissection in Japan and other Asian countries: progressing towards technical standardization. Dig Endosc. 2012;24(Suppl 1):67–72.

Tanaka S, Tamegai Y, Tsuda S, et al. Multicenter questionnaire survey on the current situation of colorectal endoscopic submucosal dissection in Japan. Dig Endosc. 2010;22(Suppl 1):S2–8.

Fujiya M, Tanaka K, Dokoshi T, et al. Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc. 2015;81:583–95.

Shi Q, Ju H, Yao LQ, et al. Risk factors for postoperative stricture after endoscopic submucosal dissection for superficial esophageal carcinoma. Endoscopy. 2014;46:640–4.

Koning GG, Rensma PL, de van Milligen Wit AW, et al. In-one-continuity rectal excision and anal mucosectomy of a giant villous adenoma: an alternative surgical approach. Case Rep Gastroenterol. 2008;2:175–80.

Oka S, Tanaka S, Saito Y, et al. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol. 2015;110:697–707.

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Springer Science and Business Media LLC

Tập 8

280-284

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