A Surgical Case of Rectal Cancer Associated with Bartter's

We report a case of Bartter's Syndrome complicated by rectal cancer, and discuss the perioperative management of Bartter's Syndrome. A 26-year-old woman was admitted because of anemia and hypokalemia. Barium enema examination revealed an apple-core sign in the rectosigmoid region. Adenocarcinoma was diagnosed on the basis of histologic examination of a biopsy specimen. Bartter's Syndrome was suspected because blood pressure was normal, despite markedly elevated levels of plasma renin activity and aldosterone, and hypokalemic metabolic alkalosis was present. Intravenous potassium canrenoate and potassium chloride were given, and after serum potassium levels had returned to normal ränge, anterior resection of the rectum was performed. The patient was given general anesthesia (50% nitrous oxide-oxygen with 0.2% to 1.0% enflurane) and epidural 2% mepivacaine. Postoperatively Bartter's Syndrome was diagnosed on the basis of preoperative findings, impaired vasopressor response to angiotensin II, and evidence of hyperplasia of the juxtaglomerular apparatus in kidney biopsy specimens.