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

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Abstract

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.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

    Yoshiko Ohara, Daisuke Watanabe, Namiko Hoshi, Soichiro Adachi, Tetsuya Yoshizaki, Fumiaki Kawara, Tsukasa Ishida, Tatsuya Okuno, Nobunao Ikehara, Yoshinori Morita, Eiji Umegaki & Takeshi Azuma

  2. Department of Endoscopy, Kobe University Hospital, Kobe, Japan

    Takashi Toyonaga & Shinwa Tanaka

  3. Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan

    Hiroshi Yokozaki

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  1. Yoshiko Ohara
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  2. Takashi Toyonaga
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  3. Daisuke Watanabe
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  15. Takeshi Azuma
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Corresponding author

Correspondence to Yoshiko Ohara.

Ethics declarations

Conflict of Interest:

Takashi Toyonaga invented the FlushKnife in collaboration with Fujifilm Inc., Tokyo, Japan, and receives royalties from its sale.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Declaration of Helsinki of 1975, as revised in 2008(5).

Informed Consent:

Informed consent was obtained from the patient included in the study.

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Ohara, Y., Toyonaga, T., Watanabe, D. et al. Electrolyte depletion syndrome (McKittrick–Wheelock syndrome) successfully treated by endoscopic submucosal dissection. Clin J Gastroenterol 8, 280–284 (2015). https://doi.org/10.1007/s12328-015-0597-4

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  • DOI: https://doi.org/10.1007/s12328-015-0597-4

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