Giant Brunner’s Gland Adenoma Presenting as Upper Gastrointestinal Bleeding in 76 Years Old Male: A Case Report

Abstract

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.

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“…They are mostly < 20 mm[ 3 , 17 ]. However, much larger lesions measuring up to 120 mm have been reported[ 19 ]. Clinically, most BGHs are asymptomatic, incidentally found in patients at the age of 50–60 years[ 2 , 3 , 15 , 17 ].…”

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“…In addition, age of the patient was older (81 years) than previously reported of 76 years old. [ 15 ]…”

Nonpolypous Hamartomas of the Gastrointestinal Tract: An Updated Review on Classification, Denominations, and Clinical Management

“…While Brunner described in 1688 the glands with the same name, Cruveilhier described first case of Brunner gland hamartoma in 1835 [ 60 ]. Then, the described lesion was separated in three entities: diffuse hyperplasia, localized hyperplasia, and hamartoma or adenoma which was recently denominated as benign glandular hyperplasia [ 10 , 60 – 63 ]. It is about nodular or pedunculated uncommon submucosal masses of the duodenum diagnosed in adults [ 10 , 60 , 61 ].…”