Duodenal Brunner's gland hamartoma resected using laparoscopic and endoscopic cooperative surgery: A case report

Abstract

Introduction and importance: Brunner's gland hamartoma is a rare benign duodenal tumor. Resection is recommended for large or symptomatic lesions, but conventional pancreaticoduodenectomy and other procedures can be overly invasive for the lesion. We report a case of Brunner's gland hamartoma resected using laparoscopic and endoscopic cooperative surgery (LECS).

Case presentation: A 51-year-old woman was referred to our hospital with an asymptomatic duodenal tumor that had increased in size. A submucosal tumor was found on the anterior wall of the duodenal bulb during a detailed examination, and surgery was performed because the tumor was large (2 cm). In order to optimally resect the tumor, duodenal LECS (D-LECS) was selected. The resection line was determined while checking the base of the lesion with an intraoperative endoscope, and after the lesion was resected, the mucosal defect was closed using laparoscopic manipulation. Histopathological evaluation revealed Brunner's gland hyperplasia and mixed smooth muscle bundles, and the lesion was diagnosed as a Brunner's gland hamartoma. The surgery was completed without any problems, and the patient made a full recovery after the surgery with no complications such as stenosis, and no recurrence was observed.

Clinical discussion: With D-LECS, the lesion can be resected without excess or deficiency, and the incision can be sutured with minimal invasiveness. D-LECS is an effective method as a treatment option for Brunner's gland hamartoma.

Conclusion: We herein report a case of Brunner's gland hamartoma treated safely with a minimally invasive surgical technique: D-LECS.

Keywords: Brunner's gland hamartoma; D-LECS; Duodenal tumor.

Fig. 1

a Esophagogastroduodenoscopy revealed a large, 20 mm SMT-like mass on the anterior wall of the duodenal bulb (arrow). b It is observed as a hypoechoic, full mass measuring 30 mm × 20 mm on EUS (arrow). c Gastrofluoroscopy reveals a 25–30 mm, borderline, well-defined elevated lesion on the anterior wall of the bulb, without obvious wall deformity or sclerosis (arrow). EUS, endoscopic ultrasound; SMT, submucosal tumor,

Fig. 2

a Intraoperative findings reveals a mass lateral to the mouth of the pyloric ring (circle). b Esophagogastroduodenoscopy reveals a mass at the mouth of the pyloric ring. c The lesion is resected with traction using an endoloop. d All layers of the lesion are incised from the mucosal surface to the serosa (circle). e The mucosal defect is sutured. f Intraoperative esophagogastroduodenoscopy confirms no bleeding or leakage (circle).

Fig. 3

a Histopathological evaluation shows a proliferation of Brunner's glands (scale bar: 100 μm). b Desmin staining shows abnormal proliferation of Brunner's glands mixed with smooth muscle bundles (scale bar: 100 μm). c MUC6 staining shows abnormal proliferation of Brunner's glands (scale bar: 100 μm).