Laparoscopic endoluminal resection of a Brunner’s gland hamartoma
Epublication WebSurg.com, Nov 2015;15(11). URL: http://websurg.com/doi/vd01en4634
Brunner glands are located in the proximal submucosal part of the duodenum. They secrete an alkaline mucin, which protects the mucosa from gastric acid. Hyperplasia of the Brunner glands larger than 1cm can evolve to a Brunner’s gland hamartoma. It is a hamartoma because the lesion does not have a capsule, a mix of acini, mucosal cells, adipose tissue, smooth muscle and Paneth cells, but no cell atypia. Such hamartomas are very rare and represent between 5 and 10% of benign duodenal tumors with the highest prevalence in patients aged between 40 and 60. The most common clinical presentation is bleeding or obstructive symptoms. Excision is recommended because of the risk of bleeding. Long-term outcome is good and no recurrence after complete excision has been reported. This video presents the case of a 40-year-old patient who was admitted to our hospital with anemia (5.1g/dL), dark stools, and a past history of Hodgkin’s lymphoma with dysfunction of the spleen and of thyroid gland. Further examination using upper GI flexible endoscopy revealed a pedunculated mass in the duodenal bulb (D1). This mass migrates through the pylorus to the antrum. Additional imaging (CT-scan, MRI) confirms the localization of the mass. Biopsy is suggestive of a Brunner’s gland hamartoma. It was decided to perform a minimally invasive approach using flexible endoscopy in combination with laparoscopy. A laparoscopic endoluminal mass resection was performed using a stapling device. The finding was confirmed on the final pathological report.