Brunner’s gland hyperplasia associated with lipomatous pseudohypertrophy of the pancreas presenting with gastrointestinal bleeding: A case report

Abstract

BACKGROUND Brunner’s gland hyperplasia (BGH) is a rare benign lesion of the duodenum. Lipomatous pseudohypertrophy (LiPH) of the pancreas is an extremely rare disease. Because each condition is rare, the probability of purely coincidental coexistence of both conditions is extremely low. CASE SUMMARY We report a 26-year-old man presenting to our hospital with symptoms of recurrent upper gastrointestinal bleeding. Upper gastrointestinal endoscopy showed a huge pedunculated polypoid lesion in the duodenum with bleeding at the base of the lesion. Histopathological examination of the duodenal biopsy specimens showed BGH. Besides, abdominal computed tomography and magnetic resonance imaging revealed marked fat replacement over the entire pancreas, confirmed by histopathological evaluation on percutaneous pancreatic biopsies. Based on the radiological and histological findings, LiPH of the pancreas and BGH were diagnosed. The patient refused any surgical intervention. Therefore, he was managed with supportive treatment. The patient’s symptoms improved and there was no further bleeding. CONCLUSION This is the first well-documented case showing the coexistence of LiPH of the pancreas and BGH.

Brunneroma: A Case of Uncommon Gastrointestinal Bleeding in a Young Adult

“…The symptomatic presentation occurs in terms of gastrointestinal bleeding as hematemesis or melena. However, there have been about 15 cases reported for acute hemorrhage leading to hypovolemic shock [5][6][7].…”

“…According to histology, BGH is a single or multiple nodular lesion comprising enlarged Brunner's glands divided by fibrous septa. The isolated mass known as Brunner's gland hamartoma comprises a variety of Brunner's glands, ducts, smooth muscle, fibrous tissue, adipose tissue, lymphocytes, etc [ 1 , 2 , 5 , 6 ]. These tubulomucinous glands release an alkaline mucin that shields the mucosa of the duodenum from an acidic pH.…”

“…BGH makes up 3.9%-10% of all benign duodenal polyps and masses. The patients are usually in their 5th or 6th decade with no gender predominance [ 1 , 2 , 6 , 7 ]. Though, this patient was relatively young.…”