Chronic microscopic enterocolitis with severe hypokalemia responding to subtotal colectomy

Area of Science:

• Gastroenterology
• Internal Medicine
• Nephrology

Background:

• Chronic watery diarrhea and hypokalemia can lead to severe complications like chronic renal failure.
• Microscopic enterocolitis, particularly with acute cryptitis and terminal ileum involvement, presents diagnostic challenges.
• Refractory cases often require exploring novel treatment strategies beyond standard medical management.

Observation:

• A 50-year-old woman presented with a 33-year history of severe chronic watery diarrhea and hypokalemia.
• Microscopic examination revealed chronic active microscopic enterocolitis with features resembling lymphocytic colitis, including acute cryptitis and terminal ileum involvement.
• Despite high-dose oral potassium supplementation, hypokalemic episodes persisted, leading to multiple hospitalizations and subsequent chronic renal failure.

Findings:

• Subtotal colon resection was performed due to the progressive and refractory nature of the patient's condition.
• Following the surgery, the patient experienced marked clinical improvement.
• Serum potassium levels normalized, and no further potassium supplementation was required post-resection.

Implications:

• This case highlights subtotal colon resection as a potentially effective treatment for severe, refractory microscopic enterocolitis causing chronic diarrhea and hypokalemia.
• The findings suggest a significant gastrointestinal origin for the electrolyte disturbance, responsive to surgical intervention.
• Further research into the specific pathophysiology and surgical indications for such rare gastrointestinal conditions is warranted.