Biliary Obstruction and Pancreatitis Caused by Diffuse Nodular Hyperplasia of Brunner’s Gland

Abstract

Albeit its uncommon clinical presentation, it can become challenging in terms of diagnosis and management. A high index of suspicion is of paramount importance for establishing the correct diagnosis and treatment.

Fatal Gastrointestinal Hemorrhage in a Patient with Brunner’s Gland Hyperplasia

“…Brunner's glands can be found throughout the duodenum; however, BGAs frequently occur more proximally and can be seen in association with acute/chronic duodenitis or erosive duodenitis [ 4 ]. BGH/BGAs are generally considered benign, and their malignant potential is unknown [ 6 ]. However, there are reports in the literature of occasional instances of malignancy developing in the background of BGH [ 3 ].…”

“…In one study, 11% of BGH/BGA were found in asymptomatic patients [ 4 ]. Those that are symptomatic can present with occult or massive upper gastrointestinal bleeding or obstructive symptoms such as nausea, vomiting, abdominal pain, and early satiety [ 1 , 4 , 5 , 6 , 7 , 8 ]. Lesions in symptomatic patients also are typically larger in size [ 8 ].…”

“…The nature of the lesion cannot always be ascertained by imaging or endoscopy, necessitating more invasive procedures to obtain tissue for histologic examination [ 8 ]. In symptomatic patients, lesions that are small and localized can be removed by endoscopy [ 1 , 4 , 5 , 6 , 7 , 8 ]. More extensive involvement may require surgical removal up to and including a pancreaticoduodenectomy [ 1 , 4 , 5 , 6 , 7 , 8 ].…”

“…In symptomatic patients, lesions that are small and localized can be removed by endoscopy [ 1 , 4 , 5 , 6 , 7 , 8 ]. More extensive involvement may require surgical removal up to and including a pancreaticoduodenectomy [ 1 , 4 , 5 , 6 , 7 , 8 ]. Asymptomatic patients are often treated conservatively with expectant management [ 4 , 8 ].…”

“…Many patients with BGH or BGA/BGH are asymptomatic. However, some present with signs and symptoms of gastrointestinal bleeding or obstruction necessitating treatment [ 1 , 4 , 5 , 6 , 7 , 8 ]. Imaging and endoscopic appearance in these cases often overlaps with that seen in malignancy, frequently leading to surgical removal [ 5 , 8 ].…”