Brunner’s gland adenoma is a rare benign tumor of small bowel, often incidentally discovered during endoscopy or radiological imaging. Mostly they are asymptomatic or often present with nonspecific symptoms such as nausea, vomiting, gastrointestinal hemorrhage, iron deficiency anemia. We reported a 76 years old male case presented with chief complaints of vomiting and black tarry stool. General physical examination was normal except mild tenderness over epigastrium. Esophagogastroduodenoscopy revealed a pedunculated polypoid tubular structure with blind end distally of length approximately 10-12* 3.5*1.5 cm in the second section of the duodenum with multiple skipped ulcers on the exposed surface of it. Additionally, there were few erosions in the duodenum proximally and multiple superficial ulcerations in the antrum, associated with helicobacter pylori confirmed by rapid urease test kit. Keywords: Brunner’s gland adenoma; Brunner’s gland hamartoma; Brunner’s gland hyperplasia; case report.

Here is a case report of a 62-year-old female who presented to our hospital with complaints of abdominal pain, unresolving severe anemia, bleeding per rectum with history of multiple blood transfusions at outside hospital. On initial investigations, the findings directed towards case of hemolytic anemia. The cause of hemolytic anemia was still unknown even after extensive clinical and laboratory investigations. Bone marrow biopsy was done, which revealed metastatic adenocarcinoma and diagnosis of cancer-related microangiopathic haemolytic anaemia (CR-MAHA) was established. Endoscopic biopsy was done from gastric growth which revealed gastric adenocarcinoma and final diagnosis of microangiopathic hemolytic anemia secondary to gastric adenocarcinoma was made. The patient’s haematological parameters improved with chemotherapy directed against the gastric adenocarcinoma. Our case supports the findings of various literature which indicates that the gastric cancer-associated MAHA responds well to the treatment with chemotherapy for primary carcinoma.