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.
Fig. 1 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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E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
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