Resección de adenoma velloso gigante causante del síndrome de Mckittrick-Wheelock

Large colorectal villous adenomas are unusual. They can cause a rectal bleeding, a chronic diarrhea and less frequently a rectal obstruction and a prolapse. In addition, they can secrete a mucinous material rich in electrolytes, causing hydroelectrolyte disturbances, dehydration and acute kidney injury. In most cases, the management of these adenomas due to their size has been surgical, but endoscopic treatment has been reported with promising results, reducing the morbidity. We report and discuss the case of a 73-year-old man, who presented with syncope, with chronic diarrhea and a hydroelectrolytic alteration. Colonoscopy revealed a granular lateral spreading tumor of the rectum, and pathology confirmed a villous adenoma with a low-grade dysplasia. An initial symptomatic management of diarrhea and electrolyte disorders was performed with a subsequent surgical treatment using pull through technique with coloanal anastomosis.

The Importance of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Predicting the Appearance of the Rectal Stenosis or Rectal Obstruction in Patients with Rectal Adenocarcinomas

The purpose of this study was to establish a correlation between markers of inflammation and the risk of rectal stenosis or obstruction, in patients with rectal adenocarcinomas. We performed a retrospective observational study on 188 patients diagnosed with rectal adenocarcinomas. We attempted to establish a correlation between the neutrophils to lymphocyte ratio(NLR), platelet to lymphocyte ratio(PLR) levels and the presence of rectal stenosis or rectal obstruction. From 188 patients included in the study, 65 patients had stenotic tumors (34.57% of cases) and 10 patients had occlusive tumors (5.31% of cases). We obtained a statistically significant correlation between the blood levels of neutrophils, lymphocytes, platelets, and the existence of rectal stenosis. (p[0.05). The cutoff value of NLR that correlates with the presence of rectal stenosis was 2.5 (95% CI: 0.426-0.574, AUC: 0.500). As for PLR, the cutoff value correlated with the presence of rectal stenosis was 106,522 (95%CI: 0.428-0.575, AUC: 0.502). We established a statistically significant correlation between NLR, PLR and rectal obstruction (p[0.05). The cutoff value of the NLR that correlates with the presence of rectal obstruction was 4.633 (95%CI: 0.614-0.751, AUC: 0.685). As for PLR, the cutoff value correlated with the presence of rectal stenosis was 345.05 (95% CI: 0.673-0.803, AUC: 0.742). Our study shows that there is a statistically significant correlation between NLR and PLR and the risk of rectal obstruction in patients with adenocarcinomas. It is still necessary to conduct prospective studies on much larger lots of patients to determine the NLR and PLR values that can predict rectal stenosis as well as rectal obstruction.