A Case of Rectal Villous Tumor with Electrolyte Depletion Syndrome

Abstract

Electrolyte depletion syndrome (EDS) is characterized by a consciousness disorder and electrolyte imbalance due to frequent diarrhea associated with villous tumors of the rectum. We report a very rare case of EDS with acute renal failure and hyperammonemia that was successfully treated with continuous hemodiafiltration (CHDF) and laparoscopic surgery. A 68-year-old woman presenting a history of liver cirrhosis was presented to our hospital with the chief complaint of a consciousness disorder. Blood examination showed hyperammonemia, decreased renal function, and electrolyte imbalance, which were resolved by hemodialysis within a few days. A huge villous tumor measuring 160 mm × 150 mm was detected using abdominal computed tomography and colonoscopy. Histological examination using biopsy revealed villous adenoma. Hypokalemia is frequently observed, even after CHDF. We performed a laparoscopic Hartmann's operation after the treatment of hypokalemia. The pathological diagnosis revealed well-differentiated tubular adenocarcinoma in the villous adenoma. The postoperative course was uneventful, with no symptoms of EDS. She recovered, within a follow-up period of 24 months. EDS should be considered when frequent diarrhea or consciousness disorder accompanies rectal villous tumors, and appropriate examination and treatment are essential.