Watery Diarrhea Hypochloremia Achlorhydria Syndrome in an 18-Month-Old Thai Girl with Chronic Secretory Diarrhea

Abstract

Watery diarrhea, associated with hypokalemia and achlorhydria (WDHA) syndrome, is caused by a hypersecretory state of the vasoactive intestinal peptide (VIP). The most usual cause of this condition involves VIP-producing tumors and a rare cause of persistent diarrhea in the pediatric age group. We reported a case of an 18-month-old girl who presented profound chronic secretory diarrhea along with severe fluid-electrolyte imbalance. Physical examination revealed severe dehydration and an abdominal mass palpated at the left upper part of the abdomen. Low stool osmotic gap, hypokalemia as well as metabolic acidosis were demonstrated. Abdominal ultrasonography and computerized tomography further documented a retroperitoneal mass at the left suprarenal area. Octreotide and chemotherapy were provided without clinical response; thus, surgical exploration for tumor removal was performed 2 months later. The histologic report identified the mass as ganglioneuroma. Additionally, the stool output and fluid electrolyte disturbance were greatly reduced after the surgical operation. WDHA syndrome is rarely prevalent among children; however, precise physical examination and imaging are important parts of the diagnosis. Tumor removal is also the treatment of choice for this condition.