A systematic review of McKittrick–Wheelock syndrome
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AbstractINTRODUCTION McKittrick–Wheelock syndrome describes the condition of extreme electrolyte and fluid depletion caused by large distal colorectal tumours, usually the benign villous adenoma. Patients generally present critically unwell with severe hyponatraemia, hypokalaemia and/or acute kidney injury.
METHODS A structured literature review was undertaken to discover what is known about this condition, which is almost universally described as rare. Important features of the syndrome were identified, including common presenting symptoms, blood results, tumour location and size.
FINDINGS Our literature search identified 257 cases reported across all languages. The most remarkable features were the long duration of symptoms (median 24 months) and the significant electrolyte derangements (median sodium of 122mmol/l and median potassium of 2.7mmol/l at initial presentation). Five key recommendations are made to improve diagnosis, including aggressive fluid resuscitation to match rectal losses and surgical intervention on the index admission. The advantages and disadvantages of different treatment options are discussed, including minimally invasive alternatives to traditional resectional surgery.
CONCLUSIONS McKittrick–Wheelock syndrome is a usually benign condition that can cause patients to become critically unwell and so it behoves all clinicians to be aware of it. By publishing recommendations based on a full literature review, we aim to improve diagnosis and management of this life threatening condition.
Acceptance Date01/10/2018
All Author(s) ListM.R. Orchard, J. Hooper, J.A. Wright, K. McCarthy
Journal nameAnnals of The Royal College of Surgeons of England
Year2018
Month11
Volume Number100
Issue Number8
Pages591 - 597
ISSN0035-8843
eISSN1478-7083
LanguagesEnglish-United Kingdom
KeywordsRectal tumour, Water–electrolyte imbalance

Last updated on 2021-13-10 at 23:42