Brunner's Gland Hyperplasia: A Massive Duodenal Lesion.

A 57-year-old male with a history of gastroesophageal reflux disease and esophageal strictures presented with melena and abdominal pain. He underwent an esophagogastroduodenoscopy, which revealed a 5-cm duodenal bulb mass causing partial obstruction of the gastric outlet. Endoscopic ultrasound showed a 5-cm, hypoechoic lesion, arising from the mucosal layer, with a large blood vessel feeding the lesion. Biopsy revealed benign Brunner's gland hyperplasia. The large mass was causing symptomatic obstruction of the pylorus and iron deficiency anemia, and had risk for malignant transformation. Due to its size it was not amenable to endoscopic removal. Subsequently, he underwent exploratory laparotomy with pyloroplasty, duodenotomy and partial duodenal resection. Surgical pathology showed Brunner's gland hyperplasia and was negative for malignancy.

Giant brunneroma originating from pylorus imitating duodenopancreatic malignancy.

Brunner's gland adenoma is usually asymptomatic and sometimes accompanied by nausea, vomiting and swelling. It is often confused with duodenal malignancy, which may mislead and the physician about its treatment. We want to present a case of a 40-year-old female with a history of weight loss, vomiting and nausea since six months. Initial imaging studies that revealed a large mass in the duodenum and endoscopic findings that suggested duodenal invagination. Whipple operation had been recommended to the patient by two different general surgery departments. The patient reported to our clinic for gastroenterological evaluation before the operation. At our exmination, a giant polyp, 5 to 6 cm in size, was observed in the second part of the duodenum; it was 9 to 10 cm long and originated from the pylorus. Duodenotomy was performed, and only the giant polyp was removed. Pathological examination revealed hyperplastic Brunner's glands mixed with fibromuscular tissue and mature fat tissue.

Laparoscopic treatment of a Brunner's gland hamartoma: a case report.

Background Brunner's gland hyperplasia is a rare benign tumour and occurs most frequently in the upper part of the duodenum, mostly in the fifth or the sixth decade. Pathogenesis is still unknown. Symptoms are mostly absent, but larger lesions can cause gastric outlet obstruction or bleeding. Biopsies are necessary for differential diagnosis and to rule out cancerous changes. Mostly a resection is required. Methods A case report of a symptomatic Brunneroma is described with a review of the literature. Results: A 72-year-old female presented with melena due to a post-pyloric Brunneroma. After medical work-up a full laparoscopic resection was performed, with an uneventful recovery. Conclusion Brunner's gland hyperplasia is a benign lesion, although malignant transformation has been described. Small pedunculated Brunneromas can be resected endoscopically, but larger lesions need surgical treatment. A full laparoscopic treatment is possible and safe.

Brunneroma: A Rare Cause of Duodeno-duodenal Intussusception.

Brunner gland hamartoma (brunneroma) is a rare benign tumor of the duodenum. It is usually asymptomatic and detected incidentally by endoscopy or other imaging modality. The definitive diagnosis is based on histopathological findings. These may mimic tumors of other natures, such as gastrointestinal stromal tumors (GIST), carcinoids, lipomas, and leiomyomas. Here, we present a case of duodenal polyp presenting with abdominal pain and obstructive symptoms that caused duodenal intussusception. It was surgically removed and found to be a brunneroma on histopathology. HOW TO CITE THIS ARTICLE: Patankar AM, Wadhwa AM, Bajaj A, Ingule A, Wagle P. Brunneroma: A Rare Cause of Duodeno-duodenal Intussusception. Euroasian J Hepato-Gastroenterol 2016;6(1):84-88.