[Synchronous adenomas of the stomach and rectum with severe protein-losing syndrome]

The authors report a case of generalized edema with low colloidal osmotic pressure of plasma in an elderly man. After the exclusion of malnutrition and any myocadic, renal or hepatic involvement it has been shown that the physiopathogenetic mechanism is based on protein-losing enteropathy. Upper and lower endoscopy of the gastrointestinal tract reveals double synchronous villous adenomas of the rectum and stomach (the latter rare but often associated with the former). It is likely that these two lesions may play an important role in the development of "anasarca" but only complete reversal of symptoms after surgical excision of tumors would demonstrate the causative relationship. The study confirms two findings already observed in the literature. The first is the increased risk of villous adenoma malignant transformation, especially where rarely located, such as in the gastric site. The other depends upon the variety of villous adenoma symptomatology. The effects of low plasmatic protein levels are prominent in this case, but clinical manifestations range form insidious signs of occult bleeding, to frank diarrhea and/or rectal bleeding, up to unusual cases of secretory diarrhea with profound dehydration and hypokalemia or malabsorption.