eP158 A New Perspective on the Management of Giant Rectal Polyps Presenting with McKittrick Wheelock syndrome: A Case Report of Treatment by Transanal Excision and Delorme’s Plication

Introduction McKittrick Wheelock syndrome is characterised by fluid deficit, electrolyte derangements and acute kidney injury caused by a villous colorectal polyp. Most small polyps are treated by endoscopic resection, and larger polyps by either surgical segmental resection or endoscopic excision. Large rectal polyps that involve a wide surface area of the rectum are much more challenging to treat by minimal access approach, due to problems with recurrence and the large rectal mucosal defect left after the excision. As a result, they have been traditionally treated by low anterior resection or abdominoperineal resection. The most challenging polyps are those involving the lower rectum, often associated with rectal prolapse. Endoscopic excision is much more difficult, and surgical resection remains the predominant treatment option. Case Report We discuss an 83-year-old female with a large low rectal polyp presenting with ‘chronic diarrhoea’, electrolyte deficiencies, acute-on-chronic kidney disease, hypoalbuminaemia and anaemia. Clinical assessment, colonoscopy, radiological imaging and histological diagnosis were consistent with a large tubulovillous adenoma with low-grade dysplasia. After physiological optimisation, the lesion was successfully treated by transanal submucosal excision and Delorme’s plication, instead of an abdominoperineal resection; there was a prompt resolution of the symptoms. Conclusion A patient with the triad of chronic diarrhoea, acute renal insufficiency and electrolyte deficiencies should have a colonoscopy to rule out a villous colorectal polyp. Low rectal polyps that are too large to be resected endoscopically could benefit from transanal excision and Delorme’s plication, instead of an abdominoperineal resection.