Unexpected cause for duodenal obstruction: Brunner's gland hyperplasia

Abstract

Brunner's gland hyperplasia is a rare benign lesion arising from the duodenum. It is often an incidental finding on endoscopy with the majority of patients being asymptomatic. It may also present with various symptoms depending on location and tumor size, such as gastrointestinal bleeding, obstruction and abdominal pain. We report an unusual case of large Brunner's gland hyperplasia in 72-years old man, admitted to hospital for epigastric pain, recurrent vomiting and significantly weight loss. Upper endoscopy showed an obstructive submucosis tumour of the bulb. Abdominal computed tomography scan revealed a circumferential thickening and stenosing mass of the first part of the duodenum leading to severe obstruction. Though pre-operative biopsies were negative, imaging studies and endoscopy were strongly suggestive of malignancy and the patient underwent duodenocephalopancreatectomy. Brunner's gland hyperplasia may have unusual presentation, mimicking malignancy. Therefore, extensive pre-operative evaluation, including repetitive tumor biopsies, is necessary to avoid radical surgical procedure.

Keywords: Adenoma; Brunner gland; Duodenum; Hyperplasia; Malignancy.