McKittrick Wheelock syndrome secondary to adenocarcinoma of the rectum: case report and diagnostic considerations

Introduction: McKittrick-Wheelock syndrome is a rare entity characterized by chronic diarrhea, acute kidney injury, and hydroelectrolytic imbalance associated with a large rectal tumor, frequently a villous adenoma. Case report: A 69-year-old male with chronic diarrhea with mucus. He underwent a colonoscopy with biopsies, reporting adenocarcinoma of the rectum in situ, and underwent a robot assisted intersphincteric resection with colo-anal anastomosis and a protecitive ileostomy. Discussion: Described in 1954, this syndrome is manifested by electrolyte imbalance and acute renal injury secondary to diarrhea associated with a rectal villous adenoma, often with long lasting symptoms. The most frequent symptom being watery diarrhea with mucus. The definitive treatment consists of surgical resection. Conclusion: Although this is a rare pathology, it should be considered as a differential diagnosis in cases of chronic diarrhea associated with water and electrolyte disorders. (AU)

Trends in the incidence of acute watery diarrhoea in the Lao People's Democratic Republic, 2009-2013

Diarrhoeal disease is the second leading cause of death in children under age 5 worldwide, with rotavirus being the main etiology. In the Lao People's Democratic Republic, acute watery diarrhoea (AWD) was introduced as one of the national notifiable diseases in 2004. We retrospectively reviewed the aggregate (n = 117 277) and case-based (n = 67 755) AWD surveillance data from 2009 to 2013 reported weekly from 1115 health facilities nationwide. Rotavirus rapid test data from all eight sentinel sites in Vientiane Capital in 2013 were also collected for analysis. The incidence of AWD ranged between 215 and 476 cases per 100 000 population and increased from 2009 to 2012 when it levelled off. The most affected age group was children under 5 who were about seven to nine times more likely to have AWD than the rest of the population (P < 0.0001). In children under 5, 74.8% of the cases were aged 0-24 months and AWD was 1.28 times more common in males (P < 0.0001). Among the 230 stool specimens tested in children under 5 in 2013, 109 (47.4%) tested positive for rotavirus. The increased AWD incidence over the study period may reflect a true increase in AWD or an improved sensitivity of the system. We recommend new mothers breastfeed up to two years after birth, which is known to reduce AWD morbidity and mortality in young children. We also recommend conducting rotavirus disease burden and cost-effectiveness studies to explore the benefits of introduction of rotavirus vaccine.

Reporte de segundo caso en Cuba de clorhidrorrea congénita / Report of a second congenital chloride diarrhea case in Cuba

La clorhidrorrea congénita es un raro desorden autosómico recesivo, causado por un defecto en el intercambio de cloruro/bicarbonato en el íleon y colon. En este trabajo se reporta el caso de un niño de 1 año de edad con características patognomónicas de esta condición, consistentes en antecedentes prenatales de polihidramnios, diarreas acuosas desde el nacimiento, poca ganancia de peso, alcalosis metabólica y deshidratación. El diagnóstico fue confirmado por el elevado contenido de cloruro en heces, y es el segundo caso reportado en la literatura cubana.

Congenital chloride diarrhea is a rare autosomal recessive disorder caused by a defective exchange of chloride and bicarbonate in the ileum and the colon. This article reported the case of one-year old child with pathognomonic characteristics of this disease including prenatal history of polyhydramnios, watery diarrheas since birth, low weight gain, metabolic alkalosis and dehydration. The diagnosis was confirmed on the basis of the high contents of chloride in stools. He is the second case of this disease reported in the Cuban literature.

Rol del equipo de investigación cubano en la identificación del origen de la epidemia de cólera en Haití / Role played by the Cuban research team in the identification of the origin of the cholera epidemic in Haiti

Objetivo: realizar la investigación epidemiológica de terreno acerca de la aparición de casos de diarreas agudas acuosas profusas y el control epidemiológico correspondiente. Métodos: se efectuó el análisis del brote de esta enfermedad con la participación del personal de salud cubano que laboraba en la comuna de Mirebalais, y se intercambiaron informaciones y criterios con el Director Departamental de Salud de Haití. Con toda la información recopilada, se comenzó la investigación epidemiológica de este evento de salud que estaba ocurriendo. Se elaboró la cronología de la aparición de los casos de la enfermedad en la comuna de Mirebalais, del Departamento Centro. Se inspeccionaron las áreas de hospitalización de los enfermos y se comprobó su estado clínico. Se dictaron otras medidas para la prevención y el control de otros casos similares. Fueron visitados, inspeccionados y analizados por el equipo de investigación cubano los asentamientos donde aparecieron casos o fallecidos por el evento epidemiológico y se efectuó la investigación ambiental en el terreno. Resultados: la rápida y oportuna alerta emitida por la brigada médica cubana sobre el aumento inusual de casos de diarreas agudas acuosas profusas permitió realizar la investigación y establecer las medidas para la prevención y el control del brote epidemiológico por el equipo de investigación cubano. Conclusiones: Al equipo médico cubano le corresponde el mérito de haber identificado precozmente el verdadero lugar donde se originaron y aparecieron los primeros casos de la epidemia de cólera en Haití.

Objective: The purpose of this study was to conduct field epidemiological research into the appearance of profuse acute watery diarrhea and the corresponding epidemiological control. Methods: An analysis was made of the outbreak of this disease with the participation of Cuban health personnel working in the commune of Mirebalais. Data and criteria were exchanged with the Haitian Departmental Director of Health. When all the required information had been gathered, the epidemiological research started. A chronology was developed of the occurrence of cases of the disease in the commune of Mirebalais, in the Central Department. Hospitalization areas were inspected and their clinical status checked. Other measures were instructed aimed at the prevention and control of similar cases. The Cuban research team visited, inspected and examined the settlements with cases or deaths caused by the epidemiological event, and a field environmental analysis was conducted. Results: The swift and timely alert issued by the Cuban medical brigade about the unusual increase in cases of profuse acute watery diarrhea made it possible to conduct the research and adopt the measures required to prevent and control the epidemiological outbreak. Conclusions: The Cuban research team had the merit of identifying at an early stage the origin and the true place where the first cholera cases appeared during the Haiti epidemic.

Pneumatosis intestinalis after adult liver transplantation / 대한외과학회지

Pneumatosis intestinalis is an uncommon disorder characterized by an accumulation of gas in the bowel wall. We described three cases undertaking liver transplantation. The patients developed diarrhea in three cases and high fever in two. An abdominal X-ray and computed tomography scan demonstrated extensive pneumatosis intestinalis in the colon with pneumoperitoneum mimicking hollow organ perforation. However, the patients had no abdominal symptoms and there was no evidence of peritonitis. The infection work-up was negative except one case with cytomegalovirus antigenemia. After one week of conservative management including bowel rest and antibiotic therapy, their pneumoperitoneum resolved spontaneously without any complication. Pneumatosis intestinalis should be considered as a differential diagnosis after adult liver transplantation with patients suffering from watery diarrhea and fever. Pneumoperitoneum, air-density in mesentery and retroperitoneum in patients with pneumatosis intestinalis without signs of peritonitis improved with conservative management, which included bowel rest and antibiotic therapy.

Microscopic colitis in patients presenting with chronic diarrhea.

Aim: To investigate the prevalence of microscopic colitis among patients presenting with chronic watery diarrhea. Material and Methods: Colonic biopsies from 400 patients presenting with chronic watery diarrhea and other symptoms pertaining to lower gastrointestinal tract were studied. After a detailed clinical history and thorough physical examination full length colonoscopy was done using flexible colonoscope. Colonic biopsies were taken from abnormal and normal areas. Three to five micron thick sections were cut and stained with hematoxylin and eosin and Masson's trichrome stain to highlight sub epithelial collagen. Results: Fifteen out of 400 (3.7%) colonic biopsies from patients presenting with chronic diarrhea had evidence of microscopic colitis. Five out of fifteen biopsies (33%) were diagnosed as collagenous colitis, 10 biopsies (67%) had evidence of lymphocytic colitis; 14/400(3.5%) histologically normal biopsies were taken as controls to compare various demographic and risk factors. Ten out of 15 patients (67%) were clinically diagnosed as irritable bowel syndrome. In the remaining five an infective etiology was suspected. On colonoscopy12/15 (80%) had no abnormality and 3/15 (20%) had mild hyperemia. Conclusion: A possibility of microscopic colitis should be considered while examining colonoscopic biopsy of a patient with chronic watery diarrhea and normal colonoscopy to avoid the misdiagnosis that may affect the treatment of patients

A Case of Malignant Duodenocolic Fistula / 대한소화기내시경학회지

Malignant duodenocolic fistula is a rare complication of colon cancer, and this usually develops as the right-side colon cancer or colonic hepatic flexure cancer infiltrates into the second portion of the duodenum. Six Korean cases of this malignancy have been previously reported on. The patients usually complain of watery diarrhea, feculant vomiting and weight loss that can be attributed to the altered normal flora. Barium enema has been the diagnostic procedure of choice to demonstrate the fistulous tract, but with the technical development of gastroendoscopy, the primary procedure is also changing. Curative resection is not possible in many cases. Palliative ileotransverse colostomy with gastrodjejunostomy is performed to relieve symptoms, but it cannot completely prevent the vomiting or diarrhea. We herein present a case of malignant duodenocolic fistula in a patient who had been suffering from indigestion, loose stool and feculant vomiting for one year. This case was diagnosed by endoscopy and the patient underwent a palliative operation.

Coinfection of Viral Agents in Korean Children with Acute Watery Diarrhea

Currently, there are a few reports on viral coinfection that causes an acute watery diarrhea in Korean children. So, to evaluate the features of coinfectious viral agents in children with acute watery diarrhea, we enrolled 155 children with acute watery diarrhea from July 2005 to June 2006. Fecal samples were collected and evaluated for various viral infections such as rotavirus, norovirus, adenovirus and astrovirus. The mean (+/-standard deviation) age of the children was 2.71+/-2.37 yr. The detection rate of viral agents was most common in children between the ages of 1 and 3 yr. Rotavirus was detected in 63 children (41.3%), norovirus in 56 (36.2%), adenovirus in 11 (7.1%), and astrovirus in 1 (0.6%). Regarding rotavirus, there were 38 (60.3%) cases with monoinfection and 25 (39.7%) with coinfection. For norovirus, there were 33 (58.9%) cases with monoinfection and 23 (41.1%) with coinfection. Coinfection with rotavirus and norovirus was most common, and occurred in 20/155 cases (12.9%) including coinfection with adenovirus. So, rotavirus and norovirus were the most common coinfectious viral agents in our study population with acute watery diarrhea.

Clorhidrorrea congénita / Congenital chloride diarrhea

Congenital chloride diarrhea (CCD) is a rare hereditary disease, with a prenatal onset, secondary to a deficit in the intestinal chloride transport. In the present study, we describe the clinical characteristics of three patients with congenital watery diarrhea, two of them females, aged between 9 and 14 months at the first visit. All patients presented perinatal antecedents of polyhydramnios and prematurity, watery stools since birth and growth failure. Metabolic alkalosis, hypokalemia and hypochloremia were found. Stool ionogram with elevated doses of chloride, exceeding both sodium and potassium, confirmed the diagnosis of CCD. Substitute treatment with sodium and potassium chloride was started with good results. CCD should be considered as a differential diagnosis to congenital watery diarrhea, since early diagnosis and appropriate treatment are mandatory for the normal development of the child, avoiding severe complications such as neurological sequelae and even death.

La clorhidrorrea congénita (CHC) es una enfermedad hereditaria rara, de comienzo prenatal secundaria aun defecto en el transporte intestinal de cloro. En este trabajo describimos las características clínicas de tres pacientes con diarrea acuosa congénita, dos desexo femenino, con edades comprendidas entre 9 y 14meses al momento de la consulta. Todos presentaban antecedentes perinatales de polihidramnios y prematurez,deposiciones líquidas desde el nacimiento y mal progreso ponderal. Se comprobó alcalosis metabólica,hipokalemia e hipocloremia. El ionograma en materia fecal, con dosajes de cloro elevado que superaban la sumade sodio y potasio, permitió confirmar el diagnóstico de CHC. Se instituyó tratamiento sustitutivo con cloruro de sodio y de potasio, con evolución favorable. Es de suma importancia tener en cuenta la CHC dentro de los diagnósticos diferenciales de diarrea acuosa congénita, ya que el diagnóstico precoz y el tratamiento adecuado permiten un desarrollo normal, evitandocomplicaciones graves, como secuelas neurológicas e incluso la muerte.