A case report of a giant rectal adenoma causing secretory diarrhea and acute renal failure: McKittrick-Wheelock syndrome.

BACKGROUND: The McKittrick-Wheelock syndrome is a rare depletion syndrome caused by a secretory villous adenoma or a carcinoma of the rectosigmoid tract. An aggressive hydroelectrolyte rebalancing is often needed, and curative treatment is obtained only with complete removal of the lesion, by endoscopy or surgery. Low clinical suspicion often delays the diagnosis, resulting in detrimental complications. CASE PRESENTATION: We report the case of a 75-year-old woman, presenting to the emergency department with acute renal failure and electrolyte imbalance, reporting an history of recurrent episodes of dehydration and chronic diarrhea. After being admitted to the nephrology department she underwent diagnostic investigation that revealed the presence of a giant adenoma of the rectum. The patients received supportive therapy and was subsequently treated with surgery, with a favorable outcome. CONCLUSIONS: A prompt diagnosis plays an important role in the treatment of McKittrick-Wheelock syndrome. We describe a case of this condition in detail and review the related literature, underlining the typical diagnostic features and exploring the possible therapeutic options.

Laparoscopic treatment gastric cancer with advanced techniques: technical notes and follow-up.

The aim of the study was to describe the development of a wholly laparoscopic total gastrectomy technique for gastric cancer. On the strength of their experience in traditional gastric surgery (about 120 operations for gastric cancer performed over the past 4 years) the authors have performed minimally invasive surgery with conviction also in the oncological field. They have also performed total gastrectomy with D2 lymphadenectomy for gastric cancer (December 2000), which is identical to that of open surgery. The innovation consists in the reconstructive phase of the operation, which is the first totally laparoscopic reconstruction to be performed in the world. At present, the case series includes 24 carefully selected patients (December 2000-December 2004). The histopathological findings on the specimen, the postoperative complication rate, the absence of complications related to the anastomosis and the follow-up data suggest, in our opinion, the substantial equivalence of the laparoscopic technique to the traditional open surgery. Our experience with advanced laparoscopic surgery has allowed our team to tackle and solve the problems involved in the wholly laparoscopic construction of an oesophageal-jejunal anastomosis after total gastrectomy for cancer. It is exactly the same technique as that employed in open surgery without having to resort to a service laparotomy or to hand-assisted surgery. No complications related to the oesophageal-jejunal anastomosis have been observed in what admittedly to date is still a very small study population.