Brunner’s gland hamartoma causing gastric outlet obstruction: case report

Proliferative lesions of Brunner’s glands > 5 mm in size are called hamartomas. Brunner’s gland hamartomas are located mainly in the first and second portions of the duodenum and are mostly asymptomatic. However, large hamartomas can lead to serious complications, such as gastric outlet obstruction. Herein, we describe the case of a patient with a large duodenal Brunner’s gland hamartoma admitted with gastric outlet obstruction, which was resected successfully endoscopically. A 59-year-old female was admitted with a history of recurrent episodes of postprandial vomiting and upper abdominal pain. Esophagogastroduodenoscopy revealed a pedunculated polyp on the duodenal bulb, causing intermittent pyloric obstruction. Endoscopic biopsies were inconclusive. Linear endosonography showed a solid lesion arising from the submucosal layer, and samples obtained by EUS-guided tissue acquisition confirmed a Brunner’s gland hamartoma. The lesion was endoscopically resected with a hot snare, and the specimen was transorally retrieved. After polyp removal, the patient’s symptoms were completely resolved. A patient with recurrent episodes of postprandial vomiting and upper abdominal pain, in the presence of a subepithelial duodenal lesion, either pedunculated or sessile, should have ruled out a Brunner’s gland hamartoma. EUS-guided tissue acquisition can confirm the diagnosis, and endoscopic resection is feasible for most cases.