RESUMO
Brunner's gland adenoma is extremely uncommon small bowel tumors with an incidence of <0.01% and account for less than 1% of all gastrointestinal tumors. They are branched acinotubular glands found within the submucosal layer and located between the pyloric ring and the major duodenal papilla. Brunner's glands produce an alkaline secretion containing viscous mucin to protect the duodenum from acidic gastric chyme. Although these lesions are usually asymptomatic and are incidentally discovered on upper gastrointestinal endoscopy, they may occasionally present with symptoms of upper gastrointestinal hemorrhage, duodenal obstruction, and more rarely with biliary fistulation or intussusception. We present an atypical case of a large 9-cm Brunner's gland adenoma causing duodenojejunal intussusception in a 44-year-old Chinese man, who presented with long-standing epigastric pain, nausea, and vomiting.
RESUMO
We present a case of a 64-year-old gentleman for whom point of care ultrasound (POCUS) expedited the diagnosis and subsequent early treatment of colon adenocarcinoma. He was referred by his primary provider to our clinic for abdominal bloating. He had no other abdominal symptoms such as abdominal pain, change in bowel habits or rectal bleeding. He had no constitutional symptoms such as weight loss. The patient's abdominal examination was also unremarkable. However, POCUS identified a 6 cm long hypoechoic circumscribed colon wall thickening around the hyperechoic pattern of bowel lumen (Pseudokidney sign)1 in the right upper quadrant, which suggested the presence of an ascending colon carcinoma. In view of this prompt bedside diagnosis, we organised a colonoscopy, staging computerised tomographic scan and colorectal surgery consultation the next day. After the locally advanced colorectal carcinoma was confirmed, the patient had curative surgery within 3 weeks of his presentation to the clinic.
