Giant Brunner's gland hamartoma: the surgical management of complex cases

Brunner's gland hamartoma (BGH) is a rare, benign tumour composed of mucin-secreting glands within the duodenal submucosa. Lesions typically range from 0.5 to 1.0cm and are usually managed endoscopically, with larger tumours occurring infrequently. This case involves a 74-year-old woman presenting with syncope. Diagnostic investigations revealed a massive BGH with a 10cm pedicle, accompanied by significant iron deficiency anaemia and intussusception. Although there are no formal, universally established guidelines, literature favours endoscopic removal because of reduced bleeding, a shorter hospital stay and lower cost. However, open surgical resection proved more appropriate owing to the lesion's size and complexity. This case highlights the challenges of managing giant BGHs and supports open surgical intervention when standard methods are unsuccessful.