McKittrick-Wheelock Syndrome (Electrolyte Depletion Syndrome).

A 67-year-old woman presented to the hospital with a 2-month history of malaise and an episode of syncope the previous day. The initial workup revealed leukocytosis, renal dysfunction, and significantly decreased serum electrolyte levels, with sodium 106 mmol/L, potassium 1.5 mmol/L, and chloride 61 mmol/L. She reported chronic diarrhea persisting for six years, and her stool was watery and slightly mucous (Picture A). Computed tomography of the abdomen showed a long segment of circumferential recto-sigmoid wall thickening (Picture B, arrows), and colonoscopy revealed a large recto-sigmoid villous tumor (Picture C and D). After intensive therapy of fluids and electrolyte replacement, low anterior resection of the recto-sigmoid colon was performed. A histopathological examination of the specimen revealed a 20-cm high- to low-grade tubulovillous adenoma (Picture E and F), with no signs of malignancy. She showed clinical improvement and was discharged 12 days after the surgery. She was asymptomatic and doing well at the three-month follow-up visit. McKittrick-Wheelock syndrome is a rare cause of severe fluid and electrolyte hypersecretion mainly associated with rectal villous adenoma (1,2).

Picture A.

Picture B.

Picture C.

Picture D.

Picture E.

Picture F.

The authors state that they have no Conflict of Interest (COI).