Organ-preserving endoscopic resection of a large colorectal lesion causing McKittrick–Wheelock syndrome

Abstract

Figures

Endoscopic resection of a large colorectal lesion causing McKittrick–Wheelock syndrome. a, b , Laterally spreading tumour extending from the rectum beyond the rectosigmoid junction. c Resection bed following Speedboat-assisted endoscopic submucosal dissection. d Final specimen measuring over 17 cm.

Full text

McKittrick–Wheelock syndrome is a rare but life-threatening condition characterised by severe diarrhoea, electrolyte disturbances, and kidney injury caused by colorectal tumours 1 . The majority of reported cases have been managed by surgical resection 2 . We demonstrate a case of McKittrick–Wheelock syndrome managed endoscopically by speedboat-assisted endoscopic submucosal dissection (S-ESD). S-ESD involves the use of a novel endoscopic electrosurgical device combining advanced bipolar radiofrequency for dissection and microwave energy for coagulation ( Video 1 ). This technique was selected to enable en-bloc resection with the potential for organ preservation, while minimising the risks associated with surgery below the peritoneal reflection, particularly in an elderly patient with multiple co-morbidities.

Speedboat-assisted endoscopic submucosal dissection (S-ESD) of a large colorectal lesion causing McKittrick–Wheelock syndrome.Video 1

The lesion was removed en-bloc completely by S-ESD ( Fig. 1 ). Our patient had an uneventful recovery without any immediate or delayed complications. Histology confirmed R0 resection of a tubulovillous adenoma with low-grade dysplasia and focal high-grade dysplasia. S-ESD using Speedboat is a safe alternative to surgery for the management of McKittrick–Wheelock syndrome especially with lesions below the peritoneal reflection to minimise complications associated with surgery.

Endoscopic resection of a large colorectal lesion causing McKittrick–Wheelock syndrome. a, b , Laterally spreading tumour extending from the rectum beyond the rectosigmoid junction. c Resection bed following Speedboat-assisted endoscopic submucosal dissection. d Final specimen measuring over 17 cm.

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