[Large Brunner's adenoma of the duodenal bulb--a case report]

Benign proliferative changes of the Brunner's glands account for about 10% of neoplasias of the duodenal bulb. Since the first description by Cruveilhier in 1835 about 120 cases have been reported in the English literature. The authors present a case of adenoma of Brunner's gland of unusual dimensions (10 x 5.5 x 2.8 cm). Clinical presentation was by melena, anemia and vague epigastric discomfort. Treatment was by laparotomy with duodenotomy and surgical polypectomy. Proliferative changes of Brunner's glands may manifest as diffuse or localized nodular hyperplasia and Brunner's adenoma. They are localized in the submucosa and small superficial endoscopic biopsies may fail to confirm the diagnosis. Malignancy seems to occur only very rarely with only 14 cases reported in the literature. As the majority of Brunner's adenomas are quite small, endoscopic polypectomy will confirm the diagnosis and cure the condition in most instances. Large symptomatic adenomas may require surgical resection.