SHM Converge Scientific Abstract ePoster Gallery-Plugging the Drain: Endoscopic Lifesaving Resection in McKittrick-Wheelock Syndrome

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This case report describes McKittrick-Wheelock syndrome (MWS), a rare condition caused by a large secretory villous adenoma that produces excessive mucin, leading to chronic diarrhea, dehydration, electrolyte disturbances, and renal dysfunction. A 90-year-old man with stage 4 chronic kidney disease, BPH, and first-degree AV block presented with four months of persistent mucus diarrhea, abdominal pain, and intermittent rectal bleeding. He had already required two hospitalizations for acute-on-chronic renal failure and hypokalemia before the diagnosis was established.<br /><br />Imaging initially showed an indeterminate rectal lesion. Colonoscopy revealed a large villous adenoma occupying about two-thirds of the rectal circumference, extending from 6 to 18 cm from the anal verge. Endoscopic ultrasound and MRI were essential in staging, showing no evidence of bowel wall invasion or lymph node metastasis. Because the patient was at high surgical risk and refused major surgery, the team opted for endoscopic mucosectomy.<br /><br />The procedure was completed successfully in 80 minutes under deep sedation, removing most of the lesion and leaving a small central area for further biopsy. Follow-up pathology excluded invasive cancer and showed high-grade dysplasia only. The patient improved clinically and biochemically, was discharged after three days, and had no further readmissions.<br /><br />The report highlights the importance of recognizing MWS in older patients with unexplained diarrhea, hypokalemia, and renal failure. It also emphasizes a multidisciplinary, patient-centered approach and shows that endoscopic resection can be an effective minimally invasive alternative to surgery in carefully selected high-risk patients.

Asset Subtitle

Lucas Gortz

Meta Tag

Author List Augusto Amaral, Eduardo Bonin, Guilherme Carelli, Jessica Machado, Leticia Bee, Lucas Gortz, Mauricio Carvalho, Wilian Wiggers

Category Clinical Vignettes

Concept McKittrick-Wheelock syndrome

Concept Rectal villous adenoma

Concept Chronic secretory diarrhea

Concept Electrolyte Imbalance

Concept Colonoscopy

Distinguished Non-Finalist

Presenter Organization Complexo Hospital De Clínicas - Universidade Federal Do Paraná (CHC-UFPR), Curitiba, Brazil

Presenting Author Lucas Gortz

Track Adult

Keywords

McKittrick-Wheelock syndrome

villous adenoma

mucus diarrhea

hypokalemia

renal dysfunction

rectal lesion

endoscopic mucosectomy

high-grade dysplasia

colonoscopy

dehydration

McKittrick-Wheelock syndrome

Rectal villous adenoma

Chronic secretory diarrhea

Electrolyte Imbalance

Colonoscopy