Brunner’s gland hyperplasia as a cause of gastric outlet obstruction  in  a seven year old boy

Ni Nyoman Metriani  Nesa; Andy  Darma; Alpha Fardah  Athiyyah; IGM Reza  Ranuh; Khadijah Rizky  Sumitro; Subijanto Marto  Sudarmo

doi:10.15562/bmj.v12i2.4484

Brunner’s gland hyperplasia as a cause of gastric outlet obstruction in a seven year old boy

Ni Nyoman Metriani Nesa ,

Andy Darma ,

Alpha Fardah Athiyyah ,

IGM Reza Ranuh ,

Khadijah Rizky Sumitro ,

Subijanto Marto Sudarmo ,

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DOI: https://doi.org/10.15562/bmj.v12i2.4484 |
Published: 2023-05-16

Abstract

Link of Video Abstract: https://youtu.be/9-ynkRS_wo8

Introduction: Brunner’s glands are acinotubular glands which are located mostly in the deep mucosal or submocosal layers of the proximal duodenum. Hyperplasia of these glands is reported in almost 1 in 50 upper gastrointestinal endoscopies and accounts for approximately 5 to 10 percent of all benign duodenal tumors. Brunner’s gland hyperplasia is usually asymptomatic. It can take form of polypoid or mass lesions and precipitate pyloric obstruction, gastrointestinal hemorrhage, and intussusception in children. Due to its rarity in pediatric population, it tends to be misdiagnosed.

Case Description: This case report presents a case of seven year old boy with Brunner’s gland hyperplasia presented with recurrent vomiting. A seven year-old boy was admitted to the hospital due to of worsening of intractable vomiting since five months prior to admission. He also felt abdominal discomfort, bloating, and early satiety since he was 3 years old. The patient had been treated with several medications without significant improvement. Epigastric pain was observed on abdominal palpation. Gastroscopy showed partial gastric outlet obstruction (pyloric obstruction), erosive gastritis, multiple ulcers, and erosive esophagitis. Histopatologic results from biopsy revealed chronic gastritis and positive for Helicobacter pylori. Abdominal CT scan showed protrusion solid lesion intraluminal with diameter 1.18 x 1 x 1.25 cm in part II duodenum. Patient was consulted to pediatric surgeon for laparotomy exploration and duodeno-duodenostomy. Excision of Brunner’s gland dan biopsy were performed. Surgical report showed gastric dilatation with duodenal wall hypertrophy on part I-II of duodenum. Histopathological from biopsy revealed Brunner’s gland hyperplasia with lymphoid tissue. Post surgery patient recovered well and eventually discharged without any complains. The prognosis was good.

Conclusion: Generally, Brunner’s gland hypertrophy is benign and has a good prognosis. However, with the growth of benign proliferative lesions of Brunner’s glands, mucosal ulcers may develop, thereby leading to the repair of gastric foveolar metaplasia with papillary architecture and then malignant transformation.

References

Dhouha B, Ahlem L, Sana BS, Saadia B, Sabeh MR. Unexpected cause for duodenal obstruction: Brunner's Gland hyperplasia. Pathologica. 2017; 109(4): 414-7.
Rocco A, Borriello P, Compare D, et al. Large Brunner’s gland adenoma: case report and literature review. World J Gastroenterol. 2006;12(12):1966–8.
Franzin G, Musola R, Ghidini O, Manfrini C, Fratton A. Nodular hyperplasia of Brunner’s glands. Gastrointest Endosc 1985;31:374-8.
Urganci N, Arapoglu M, Akyildiz B, et al. Brunner's gland adenoma: a rare cause of vomiting. Acta Paediatr 2005;94(5):631-3.
Lee WC, Yang HW, Lee YJ, Jung SH, Choi GY, Go H, et al. Brunner’s gland hyperplasia: Treatment of severe diffuse nodular hyperplasia mimicking a malignancy on pancreatic-duodenal area. J Korean Med Sci 2008;23:540-3.
Buchanan EB. Nodular Hyperplasia of Brunner’s the Duodenum Glands of. 1961;101
El Faleh I, Lutz N, Osterheld MC, Reinberg O, Nydegger A. Gastric outlet obstruction by Brunner’s gland hyperplasia in an 8-year-old child. J Pediatr Surg. 2009;44(4):e21–4.
Patel ND, Levy AD, Mehrotra AK, Sobin LH. Brunner's gland hyperplasia and hamartoma:Imaging features with clinicopathologic correlation. AJR. 2006; 187: 715-722.
Zhu M, Li H, Wu Y, An Y, Wang Y, Ye C, et al. Brunner's gland hamartoma of the duodenum: a literature review. Adv Ther. 2021; 38: 2279-94.
Destek S, Onur Gul. Brunner's glandy hyperplasias and hamartomas in association with Helicobacter pylori. Canadian journal of Gastroenterology and hepatology. 2019. https://doi.org/10.1155/2019/6340565.
Krisnamurthy P, Junaid O, Moezzi J, Ali SA, Gopalswamy N. Gastric outler obstruction caused by Brunner's gland hyperplasia: case report and review of literature. Gastrointestinal endoscopy. 2006; 64(3): 464-467.
Jung SH, Chung WC, Kim EJ, et al. Evaluation of non-ampullary duodenal polyps: comparison of non-neoplastic and neoplastic lesions. World J Gastroenterol. 2010;16(43):5474–80.
Bojanapu S, Mangdla V, Mehrotra S, Lalwani S, Mehta N, Nundy S. Brunner's gland hyperplasia : an unusual duodenal submocosal lesion seen in four patients. Journal of surgical case reports. 2018; 11: 1-5.
Kim K, jang SJ, Song HJ, Yu E. Clinicopathologic characteristics and mucin expression in Brunner's gland proliferating lesions. Dig Dis sci. 2013; 58: 194-201.
Peloso A, Vigano` J, Vanoli A, et al. Saving from unnecessary pancreaticoduodenectomy. Brunner’s gland hamartoma: case report on a rare duodenal lesion and exhaustive literature review. Ann Med Surg Lond. 2017;17:43–9.

[1] Dhouha B, Ahlem L, Sana BS, Saadia B, Sabeh MR. Unexpected cause for duodenal obstruction: Brunner's Gland hyperplasia. Pathologica. 2017; 109(4): 414-7.

[2] Rocco A, Borriello P, Compare D, et al. Large Brunner’s gland adenoma: case report and literature review. World J Gastroenterol. 2006;12(12):1966–8.

[3] Franzin G, Musola R, Ghidini O, Manfrini C, Fratton A. Nodular hyperplasia of Brunner’s glands. Gastrointest Endosc 1985;31:374-8.

[4] Urganci N, Arapoglu M, Akyildiz B, et al. Brunner's gland adenoma: a rare cause of vomiting. Acta Paediatr 2005;94(5):631-3.

[5] Lee WC, Yang HW, Lee YJ, Jung SH, Choi GY, Go H, et al. Brunner’s gland hyperplasia: Treatment of severe diffuse nodular hyperplasia mimicking a malignancy on pancreatic-duodenal area. J Korean Med Sci 2008;23:540-3.

[6] Buchanan EB. Nodular Hyperplasia of Brunner’s the Duodenum Glands of. 1961;101

[7] El Faleh I, Lutz N, Osterheld MC, Reinberg O, Nydegger A. Gastric outlet obstruction by Brunner’s gland hyperplasia in an 8-year-old child. J Pediatr Surg. 2009;44(4):e21–4.

[8] Patel ND, Levy AD, Mehrotra AK, Sobin LH. Brunner's gland hyperplasia and hamartoma:Imaging features with clinicopathologic correlation. AJR. 2006; 187: 715-722.

[9] Zhu M, Li H, Wu Y, An Y, Wang Y, Ye C, et al. Brunner's gland hamartoma of the duodenum: a literature review. Adv Ther. 2021; 38: 2279-94.

[10] Destek S, Onur Gul. Brunner's glandy hyperplasias and hamartomas in association with Helicobacter pylori. Canadian journal of Gastroenterology and hepatology. 2019. https://doi.org/10.1155/2019/6340565.

[11] Krisnamurthy P, Junaid O, Moezzi J, Ali SA, Gopalswamy N. Gastric outler obstruction caused by Brunner's gland hyperplasia: case report and review of literature. Gastrointestinal endoscopy. 2006; 64(3): 464-467.

[12] Jung SH, Chung WC, Kim EJ, et al. Evaluation of non-ampullary duodenal polyps: comparison of non-neoplastic and neoplastic lesions. World J Gastroenterol. 2010;16(43):5474–80.

[13] Bojanapu S, Mangdla V, Mehrotra S, Lalwani S, Mehta N, Nundy S. Brunner's gland hyperplasia : an unusual duodenal submocosal lesion seen in four patients. Journal of surgical case reports. 2018; 11: 1-5.

[14] Kim K, jang SJ, Song HJ, Yu E. Clinicopathologic characteristics and mucin expression in Brunner's gland proliferating lesions. Dig Dis sci. 2013; 58: 194-201.

[15] Peloso A, Vigano` J, Vanoli A, et al. Saving from unnecessary pancreaticoduodenectomy. Brunner’s gland hamartoma: case report on a rare duodenal lesion and exhaustive literature review. Ann Med Surg Lond. 2017;17:43–9.

Brunner’s gland hyperplasia as a cause of gastric outlet obstruction in a seven year old boy

Abstract

References

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