Endoscopic management of a rare case of obstructive giant duodenal Brunner’s gland hamartoma

• Main Authors: Gelu C. Rosianu, Anca Evsei, Mircea Gheorghe, Adelina Birceanu-Corobea, Narcis Copca
• Format: Article
• Language: English
• Published: Balkan Medical Union 2017-12-01
• Series: Archives of the Balkan Medical Union
• Subjects: giant hamartoma; Brunner's gland; endoscopic resection
• Online Access: http://umbalk.org/wp-content/uploads/2017/12/14.ENDOSCOPIC-MANAGEMENT-OF-A-RARE-CASE.pdf

Introduction. Brunner’s gland hamartomas are very uncommon. They are small, benign lesions, frequently located in the bulb of the duodenum. Usually found incidentally during routine esophago-gastro-duodenoscopies, these lesions are frequently asymptomatic, but some patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Surgical excision is required, especially if the lesion has large dimensions. The pathological examination is the most important in confirming the diagnosis.Case presentation. We report a case of a 64-year-old female patient, who presented to the emergency room for vomiting partially digested food, without blood. Upper digestive endoscopy revealed a polypoid mass, with a 1 cm stalk, located in the duodenal bulb. The polyp was successfully endoscopically resected and the pathological diagnosis was of Brunner’s gland hamartoma. Histologically, this polyp consisted of the components of Brunner’s gland cells, as well as glandular, adipose and muscle cells. Conclusions. Brunner’s gland hamartomas are rare duodenal tumors occurring in middle-aged patients that present either with gastrointestinal hemorrhage, obstructive symptoms or as an incidental finding. Surgical or endoscopic excision is uncomplicated, and the long-term outcome is favorable. The particularity of our case is given by the fact that this lesion was very large, it caused symptoms such as vomiting and was managed solely by endoscopic resection.