Male, 62 years old, rural, with no morbid history.
She was admitted to the hospital after a lipothymia with electrocardiographic changes suggestive of myocardial ischemia, which was subsequently discarded.
She had suffered from severe diarrhea, and had been suffering from watery diarrhea for 8 years.
On admission there was severe hypokalemia (13 mEq/L), hyponatremia (13 mEq/L), and renal dysfunction (urea nitrogen 81 mg/dl, creatinine 1.68 mg/dl).
Blood count, calcemia, albuminemia were normal.
The patient was treated with parenteral hydration and potassium during the first week, achieving potassium concentrations above 3.5 mEq/L, persistent diarrhoea (three episodes daily).
On the 6th day of evolution, the patient developed hypotension, oliguria haemodialysis and mEqL of the renal dysfunction (urea nitrogen 138 mg/dl, creatinine 8.0 mg/dl), and hypobinatremia (120 metabolic requirement 8.3 l/L).
The rectal examination revealed a hypertonic sphincter and the rectum was occupied by a renitent mass that compromised its perimeter.
Abdominal and pelvic echotomography described a 7 cm diameter rectal ampulla with solid material inside.
During the second and third week of hospitalization, renal function improved significantly (creatinine 2.56 mg/dl), always under the administration of parenteral hydration solutions and potassium intakes.
The colon showed an extensive flat lesion with an adenoma appearance between 5 and 20 cm from the anal margin.
A rectal biopsy revealed a villous adenoma with severe epithelial dysplasia.
The diagnosis of McKittrick-Wheelock syndrome, resection of the tumor, was proposed.
At day 49 of hospitalization, anterior resection of the rectum was performed with end-to-end anastomosis.
Biopsy of the surgical specimen was reported as a villous adenoma of the rectal mucosa with microlithiasis of adenocarcinoma in situ.
The resection margins were tumor free and the lymph nodes did not contain metastasis.
The patient was discharged without diarrhea and normal renal function and metabolic disorders.
Subsequent outpatient controls were asymptomatic.
