Secretory Diarrhea in a Villous Tumor of Rectum: Relation to Prostaglandin E₂, and Cyclinc AMP

Yutaka Tokuda, Kaishu Nagai, Kyoichi Mizutani, Hitoshi Hanaue, Fumiaki Ueno¹⁾, Toshio Mitomi²⁾

Division of Surgery and Internal Medicine¹⁾, Oiso Hospital, and The 2nd Department of Surgery²⁾, Tokai University School of Medicine

Massive secretory diarrhea is associated with some villous tumors. The mechanism of this secretion is unknown. A 75-year-old woman had a 12×10 cm villous tumor of the rectum with prerenal uremia, severe hyponatremia, and hypokalemia due to massive diarrhea. The volume of the rectal fluid discharge was 1100∼3500 gm/day, with sodium and potassium concentrations and osmolarity of 149 mEq/l, 34.5 mEq/l, and 330 mOsm/kg, respectively. Indomethacin treatment had some effect on the rectal fluid loss associated with a reduction in rectal prostaglandin E₂, (PGE₂) excretion. Following rehydration and restoration of normal serum electrolytes, an abdominoperineal rectum resection was carried out. The postoperative course was uncomplicated and the patient was asymptomatic. We have compared the PGE₂ and cyclic AMP content of the tumor with that of the nomal rectal mucosae. The cyclic AMP content of the tumor was higher than that of the normal mucosa, although the tumor PGE₂ content was not elevated. These results suggest that the massive diarrhea in our patient may have been related to increased adenylate cyclase activity.

Key words
villous tumor, secretory diarrhea, cyclic AMP

Reprint requests
Yutaka Tokuda The 2nd Department of Surgery, Tokai University School of Medicine
Bohseidai, Isehara, 259-11 JAPAN

Accepted
October 11, 1989

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