# Surgical Treatment of a Severe Electrolyte Imbalance: A Case Report of an Elderly Patient With McKittrick–Wheelock Syndrome

## TL;DR

An elderly patient with a rare syndrome causing severe electrolyte imbalance and chronic diarrhea underwent surgery after multiple failed treatments.

## Contribution

This case report demonstrates the rare need for surgical intervention in managing McKittrick–Wheelock syndrome.

## Key findings

- The patient had a large rectal polyp diagnosed 10 years prior, which contributed to chronic electrolyte imbalances.
- Abdominoperineal resection of the rectum was performed, revealing a low-grade rectal carcinoma.
- Surgical intervention was necessary after multiple unsuccessful endoscopic attempts and persistent symptoms.

## Abstract

McKittrick–Wheelock is a rare syndrome characterized by a severe, difficult to correct electrolyte imbalance, chronic mucus diarrhea, and a large rectal polyp. In this case report, we describe an elderly patient diagnosed with a large nonmalignant rectal polyp during a routine colonoscopy 10 years prior to admission. For years, the patient has suffered from diarrhea, causing episodic life-threatening hypokalemia and hyponatremia with several unsuccessful attempts at endoscopic polyp removal. Due to symptomatic cholelithiasis, the patient was transferred to the surgical ward and diagnosed with McKittrick–Wheelock syndrome. The patient had undergone cholecystectomy and, after a period of preoperative preparation, underwent an abdominoperineal resection of the rectum. Histopathologic evaluation revealed a low-grade (G1) rectal carcinoma. This case report highlights the importance of a careful assessment of patients with electrolyte level disturbances, with some, albeit very rarely, requiring surgical intervention.