Background: Using a typical case the symptomatology, the clinical course, the diagnostics with its difficulties as well as the therapy of the rare secreting villous adenoma with severe electrolyte and fluid depletion syndrome are described. SYMPTOMATOLOGY AND CLINICAL COURSE: Initially the patients show the presence of a secretory diarrhea, existing over several years, which can be compensated by increased oral fluid intake and renal mechanisms. Often the chronic course is not given adequate notice by patient and consulting physician alike. By an increase of the mucous volume together with an exhaustion of the physiological compensation mechanisms a life-threatening condition with severe electrolyte and fluid loss as well as acute prerenal failure develops, which can lead to difficulties in the diagnosis finding. Therefore, especially in case of a triade of prerenal failure, electrolyte disorder and chronic diarrhea, the existence of an intestinal villous adenoma should be considered.
Treatment: After restoration of the homeostasis, the surgical removal of the infested intestine section should be the first aim, in order to eliminate the chronic electrolyte and fluid loss and detect or prevent a malignant degeneration. Only in exempt cases an endoscopic treatment or a drug therapy with indometacin can alternatively be considered.
Prognosis: Before the malignant degeneration has set in, an early operative sanitation always leads to a complete recovery. An untreated secreting villous adenoma on the other side shows a mortality of 100%.