Giant hemorrhagic hamartoma of the Brunner's of duodenum: a case report

A 56-year-old woman presented with hematemesis and melena. She was hemodynamically stable, with hemoglobin at 5.2 g/dL. Upper gastrointestinal endoscopy after transfusion showed twisting of the second duodenum (D2). Computed tomography and magnetic resonance imaging revealed intussusception caused by a duodenal mass without ischemia. Endoscopic ultrasound was inconclusive, and tumor markers were normal. Exploratory laparotomy found no peritoneal carcinomatosis. Duodenotomy exposed a 7 cm pedunculated submucosal tumor in D 2. Cannulation of the cystic duct identified the papilla, and an Escat drain was inserted. The mass was resected using Endo-GIA. Postoperative recovery was uneventful; the drain was removed on Day 3, and the patient was discharged on Day 4. Histopathology confirmed a completely resected benign Brunner's gland harmartoma. After four years, no recurrence was observed. Brunner's gland hamartomas are benign tumors. Surgery is indicated when endoscopic treatment is not feasible.