Brunner's Gland Hyperplasia: A Massive Duodenal Lesion

Intestinal obstruction secondary to Brunner's glands hyperplasia

Brunner's gland hyperplasia constitutes 10.6% of benign tumors of the duodenum, with an incidence of 0.008%. It is usually an incidental finding during endoscopy or imaging tests as they are small and asymptomatic. In the case of symptomatic tumors, resection of the lesion is indicated. In lesions ≤2 cm, endoscopic resection can be chosen, reserving surgery for larger lesions or endoscopically inaccessible ones. We present the case of a patient with a history of vomiting and hyporexia of months of evolution who presented peptic ulcer perforation and underwent surgery. During follow-up, she presented intestinal obstruction due to pyloric stenosis. Given the impossibility of ruling out a neoplastic process with certainty in diagnostic tests, surgical resection (antrectomy) was decided with an anatomopathological finding of Brunner's gland hyperplasia.

Brunneroma: A Case of Uncommon Gastrointestinal Bleeding in a Young Adult

Brunner's gland hyperplasia (BGH) or Brunneroma is an uncommon benign proliferative lesion of the small intestine. It is primarily found in the duodenal submucosa, and its main function is to create an alkaline-based mucus to protect the duodenum from stomach acid. BGH can manifest as hyperplasia or a polypoidal tumor and is often discovered incidentally during endoscopy or imaging. Less than 200 cases have been reported in the literature, and it rarely causes gastrointestinal bleeding. In this case report, we present a case of a 25-year-old male who presented with bloody stools and fainting due to severe anemia and underlying gastrointestinal pathology.

Feasibility of endoscopic resection for large pedunculated duodenal lesions (with video)

BACKGROUND

A standard treatment method for pedunculated duodenal lesions has not yet been established. This study aimed to evaluate the feasibility of endoscopic resection (ER) for pedunculated duodenal lesions, especially for large lesions.

METHODS

This study retrospectively reviewed cases of pedunculated duodenal lesions treated with ER at our institute between July 2010 and January 2021. We collected data on the clinical characteristics and treatment outcomes. In addition, the cases were divided based on the treatment provided for the lesion, i.e., the ESD and snare resection groups, and we compared the data between the two groups.

RESULTS

Thirty-eight cases were included in this study. The overall en bloc resection rate was 95%. No perforation occurred in any of the cases. There were 10 cases treated with ESD, which were considered difficult to achieve en bloc resection using snare forceps, and 28 cases treated with snare resection. Although the median lesion size was significantly larger in the ESD group than in the snare resection group (27 [range 23-66] vs. 19 [range 6-55] mm, P = 0.0052), treatment outcomes were not significantly different between the two groups. Among the 10 cases treated using ESD, en bloc resection was achieved in all cases, along with specimen retrieval without any perforations, despite the large size of the lesions.

CONCLUSION

ER could be performed to achieve a high en bloc resection rate without any perforations in pedunculated duodenal lesions, even in extremely large (e.g., ≧ 60 mm) lesions, suggesting that ER is feasible and may be an alternative to surgical resection for large pedunculated duodenal lesions.