A 56-year-old woman presented to the emergency department with asthenia, anorexia, nausea and weight loss.
It was decided to perform an outpatient study, but in one of his visits he was admitted to hospital due to acute renal failure with symptomatic hyponatremia and symptoms of intestinal obstruction.
The patient reported hypothyroidism, hypercholesterolemia in treatment and recurrent nephritic colic with known renal lithiasis.
Upon admission, the patient has an acceptable general condition, with a blunt abdomen and depressible without pain; there are no masses or enlargements.
The rectal examination shows an excrecent mass tip.
Analytically, hyponatremia is associated with hypokalemia.
Abdominal X-ray shows dilation of the colonic frame.
Abdominal echo is requested where only a dilatation of the right foot and a CT of the abdomen is detected in which there is a dilatation of the sigmoid and rectum with abundant fluid.
A large villous mural lesion is seen inside the rectum.
Endoscopic examination revealed an extensive villous adenoma 4 cm from the anal margin, which was not eligible for treatment.
During the test a biopsy was taken that classified the lesion as a villous adenoma with low-grade dysplasia.
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It was decided to remove the adenoma by transanal resection, which did not achieve complete excision due to the vesicular size. It was decided to perform a low anterior resection.
After 6 days of hospital stay the patient is discharged.
Anatomopathological analysis of the specimen showed three coalescent tubulovillous adenomas, with low-grade dysplasia, larger than 14 cm.
