Diarrea Crónica, un Severo Trastorno Electrolítico y Mckittrick-Wheelock Como un Diferencial Potencialmente Mortal

Abstract

Background

Chronic diarrhea and electrolyte disorder that can be accompanied by kidney failure are part of Mckittrick-Wheelock syndrome, a little-known entity resulting from a hypersecretory tumor, usually villous adenoma located at the colorectal level.

The case: 

A 75-year-old female patient presents to the emergency department with diffuse abdominal pain, associated with weight loss and diarrhea. Three days prior to admission, she experienced increased pain intensity, which is why she consulted. Physical examination: hypotension, tachycardia, soft and tender abdomen and a mass palpated in the right hemiabdomen, without signs of peritoneal irritation. Laboratory: mild anemia and severe hypokalemia. CT-TAP reported extensive mass in the cecum and ascending colon. A colonoscopy was performed that described a stenosing lesion in the ascending colon. Biopsy shows HGD tubular adenoma. Surgical management was decided after hydroelectrolyte correction. Right hemicolectomy was performed without complications during or after the procedure.

Conclusion

Mckittrick-Wheelock syndrome is an unusual condition associated with hypersecreting colorectal tumors. Its characterized by chronic high-volume diarrhea and hydroelectrolyte imbalances. The treatment is surgical and consists of its resection. Mortality without treatment is 100%, so early diagnosis is crucial. In this case it was initially considered as a differential diagnosis due to severe hypokalemia, but was later ruled out due to biopsy findings.

KEY WORDS: diarrhea, hypokalemia, colonic neoplasms, villous adenoma, coloproctology