RESUMO
Introduction: McKittrick-Wheelock syndrome is a rare entity characterized by chronic diarrhea, acute kidney injury, and hydroelectrolytic imbalance associated with a large rectal tumor, frequently a villous adenoma. Case report: A 69-year-old male with chronic diarrhea with mucus. He underwent a colonoscopy with biopsies, reporting adenocarcinoma of the rectum in situ, and underwent a robot assisted intersphincteric resection with colo-anal anastomosis and a protecitive ileostomy. Discussion: Described in 1954, this syndrome is manifested by electrolyte imbalance and acute renal injury secondary to diarrhea associated with a rectal villous adenoma, often with long lasting symptoms. The most frequent symptom being watery diarrhea with mucus. The definitive treatment consists of surgical resection. Conclusion: Although this is a rare pathology, it should be considered as a differential diagnosis in cases of chronic diarrhea associated with water and electrolyte disorders. (AU)
Assuntos
Humanos , Masculino , Idoso , Neoplasias Retais , Adenocarcinoma , Adenoma Viloso , Desequilíbrio Hidroeletrolítico , Diarreia , Doenças do Sistema Digestório/diagnóstico por imagemRESUMO
La clorhidrorrea congénita es un raro desorden autosómico recesivo, causado por un defecto en el intercambio de cloruro/bicarbonato en el íleon y colon. En este trabajo se reporta el caso de un niño de 1 año de edad con características patognomónicas de esta condición, consistentes en antecedentes prenatales de polihidramnios, diarreas acuosas desde el nacimiento, poca ganancia de peso, alcalosis metabólica y deshidratación. El diagnóstico fue confirmado por el elevado contenido de cloruro en heces, y es el segundo caso reportado en la literatura cubana.
Congenital chloride diarrhea is a rare autosomal recessive disorder caused by a defective exchange of chloride and bicarbonate in the ileum and the colon. This article reported the case of one-year old child with pathognomonic characteristics of this disease including prenatal history of polyhydramnios, watery diarrheas since birth, low weight gain, metabolic alkalosis and dehydration. The diagnosis was confirmed on the basis of the high contents of chloride in stools. He is the second case of this disease reported in the Cuban literature.
Assuntos
Humanos , Poli-Hidrâmnios/diagnóstico , Vipoma/complicações , Antiportadores de Cloreto-Bicarbonato/efeitos adversos , Relatos de CasosRESUMO
Objetivo: realizar la investigación epidemiológica de terreno acerca de la aparición de casos de diarreas agudas acuosas profusas y el control epidemiológico correspondiente. Métodos: se efectuó el análisis del brote de esta enfermedad con la participación del personal de salud cubano que laboraba en la comuna de Mirebalais, y se intercambiaron informaciones y criterios con el Director Departamental de Salud de Haití. Con toda la información recopilada, se comenzó la investigación epidemiológica de este evento de salud que estaba ocurriendo. Se elaboró la cronología de la aparición de los casos de la enfermedad en la comuna de Mirebalais, del Departamento Centro. Se inspeccionaron las áreas de hospitalización de los enfermos y se comprobó su estado clínico. Se dictaron otras medidas para la prevención y el control de otros casos similares. Fueron visitados, inspeccionados y analizados por el equipo de investigación cubano los asentamientos donde aparecieron casos o fallecidos por el evento epidemiológico y se efectuó la investigación ambiental en el terreno. Resultados: la rápida y oportuna alerta emitida por la brigada médica cubana sobre el aumento inusual de casos de diarreas agudas acuosas profusas permitió realizar la investigación y establecer las medidas para la prevención y el control del brote epidemiológico por el equipo de investigación cubano. Conclusiones: Al equipo médico cubano le corresponde el mérito de haber identificado precozmente el verdadero lugar donde se originaron y aparecieron los primeros casos de la epidemia de cólera en Haití.
Objective: The purpose of this study was to conduct field epidemiological research into the appearance of profuse acute watery diarrhea and the corresponding epidemiological control. Methods: An analysis was made of the outbreak of this disease with the participation of Cuban health personnel working in the commune of Mirebalais. Data and criteria were exchanged with the Haitian Departmental Director of Health. When all the required information had been gathered, the epidemiological research started. A chronology was developed of the occurrence of cases of the disease in the commune of Mirebalais, in the Central Department. Hospitalization areas were inspected and their clinical status checked. Other measures were instructed aimed at the prevention and control of similar cases. The Cuban research team visited, inspected and examined the settlements with cases or deaths caused by the epidemiological event, and a field environmental analysis was conducted. Results: The swift and timely alert issued by the Cuban medical brigade about the unusual increase in cases of profuse acute watery diarrhea made it possible to conduct the research and adopt the measures required to prevent and control the epidemiological outbreak. Conclusions: The Cuban research team had the merit of identifying at an early stage the origin and the true place where the first cholera cases appeared during the Haiti epidemic.
Assuntos
Humanos , Surtos de Doenças/prevenção & controle , Diarreia/epidemiologia , Diarreia/prevenção & controle , Pesquisa Ambiental/métodos , Pesquisa Ambiental/prevenção & controleRESUMO
Congenital chloride diarrhea (CCD) is a rare hereditary disease, with a prenatal onset, secondary to a deficit in the intestinal chloride transport. In the present study, we describe the clinical characteristics of three patients with congenital watery diarrhea, two of them females, aged between 9 and 14 months at the first visit. All patients presented perinatal antecedents of polyhydramnios and prematurity, watery stools since birth and growth failure. Metabolic alkalosis, hypokalemia and hypochloremia were found. Stool ionogram with elevated doses of chloride, exceeding both sodium and potassium, confirmed the diagnosis of CCD. Substitute treatment with sodium and potassium chloride was started with good results. CCD should be considered as a differential diagnosis to congenital watery diarrhea, since early diagnosis and appropriate treatment are mandatory for the normal development of the child, avoiding severe complications such as neurological sequelae and even death.
La clorhidrorrea congénita (CHC) es una enfermedad hereditaria rara, de comienzo prenatal secundaria aun defecto en el transporte intestinal de cloro. En este trabajo describimos las características clínicas de tres pacientes con diarrea acuosa congénita, dos desexo femenino, con edades comprendidas entre 9 y 14meses al momento de la consulta. Todos presentaban antecedentes perinatales de polihidramnios y prematurez,deposiciones líquidas desde el nacimiento y mal progreso ponderal. Se comprobó alcalosis metabólica,hipokalemia e hipocloremia. El ionograma en materia fecal, con dosajes de cloro elevado que superaban la sumade sodio y potasio, permitió confirmar el diagnóstico de CHC. Se instituyó tratamiento sustitutivo con cloruro de sodio y de potasio, con evolución favorable. Es de suma importancia tener en cuenta la CHC dentro de los diagnósticos diferenciales de diarrea acuosa congénita, ya que el diagnóstico precoz y el tratamiento adecuado permiten un desarrollo normal, evitandocomplicaciones graves, como secuelas neurológicas e incluso la muerte.