Brunner's gland hamartoma masquerading as duodenal stricture: a case report

Brunner's gland hamartoma is an infrequent benign lesion (0.008% incidence) that originates in the submucosa of the duodenum. The increased clinical attention to frequently addressed pathologies such as malignancies, peptic ulcer disease, and adhesions in stricture causation often overshadows such uncommon underlying lesions.

A 56-year-old male presented with a history of progressively worsening symptoms of gastric outlet obstruction, including upper abdominal pain and projectile vomiting for 2 weeks. The patient had a history of peptic ulcer. Imaging through contrast enhanced computed tomography scan and endoscopic observations unveiled duodenal stricture. Antrectomy followed by Billroth type-II gastrojejunostomy was performed. Finally, Brunner's gland hamartoma without dysplasia or malignancy was identified through histopathological evaluation. The patient recovered gradually and was discharged on postoperative day 5 in stable condition.

Most asymptomatic patients are managed conservatively, whereas a small subset of symptomatic patients with obstruction or bleeding is indicated for surgical or endoscopic resection. Though useful, the utility of advanced imaging techniques and endoscopy often yields inconclusive or benign conclusions. Consistent with our case findings, a definitive diagnosis relies exclusively on tissue biopsy analysis.

Rare presentation, non-specific clinical manifestations, and unclear etiology makes Brunner's gland hamartoma an incidental diagnostic finding, often missed during routine investigations.