Successful surgical excision of a massive symptomatic partially obstructing Brunner's gland hamartoma: a case report

Brunner gland function within the duodenal epithelium is secretion of alkaline mucin to counteract acidic chyme. These glands may grow beyond the duodenal wall to become hamartomas. Rarely, they become large enough to cause obstructive symptoms in the upper gastrointestinal tract. We report a case of one of the largest lesions identified in the literature causing obstruction symptoms. A previously asymptomatic 65-year-old gentleman presented to the emergency department with a single-day history of colicky abdominal pain, cramping and vomiting. After initial imaging with computed tomography was inconclusive, a subsequent esophagogastroduodenoscopy with biopsy and small bowel series was performed indicating a pedunculated polypoid mass. Our patient underwent an uncomplicated exploratory laparotomy with duodenotomy and Heineke-Mikulicz pyloroplasty for resection of a massive Brunner's gland hamartoma. For similar presentations, we recommend this technique.