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Surgical management of giant Brunner's gland hamartoma: case report and literature review.

Stewart ZA, Hruban RH, Fishman EF, Wolfgang CL - World J Surg Oncol (2009)

Bottom Line: Brunner's gland hamartomas (BGH) are uncommon benign tumors of the duodenum forming mature Brunner's glands.We report here an unusual case of a giant BGH that was not amenable to endoscopic or surgical local resection thus requiring a pancreaticoduodenectomy for extirpation.The relevant literature is discussed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Hospital, Baltimore, Maryland, USA. zstewart@jhmi.edu

ABSTRACT
Brunner's gland hamartomas (BGH) are uncommon benign tumors of the duodenum forming mature Brunner's glands. We report here an unusual case of a giant BGH that was not amenable to endoscopic or surgical local resection thus requiring a pancreaticoduodenectomy for extirpation. The relevant literature is discussed.

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Related in: MedlinePlus

Appearance of a Giant Brunner's Gland Hamartoma on Computed Tomography Scan. (a) Contrast enhanced axial image in arterial phase of acquisition demonstrates an approximately 10 cm mass in duodenum extending into the gastric antrum (white arrow) with both solid (yellow arrow) and cystic components (blue arrow) (b) coronal display shows the intraluminal nature of the mass (white arrow) and its extent as well as again defining both the solid (yellow arrow) and cystic components (blue arrow).
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Figure 1: Appearance of a Giant Brunner's Gland Hamartoma on Computed Tomography Scan. (a) Contrast enhanced axial image in arterial phase of acquisition demonstrates an approximately 10 cm mass in duodenum extending into the gastric antrum (white arrow) with both solid (yellow arrow) and cystic components (blue arrow) (b) coronal display shows the intraluminal nature of the mass (white arrow) and its extent as well as again defining both the solid (yellow arrow) and cystic components (blue arrow).

Mentions: The patient was referred to our institution and evaluated by a multidisciplinary gastrointestinal oncology team. CT imaging at that time demonstrated a massive intraluminal mass extending from the antrum through the duodenum (Figure 1). Based on this finding and previous failed attempts at endoscopic management it was decided that this tumor could not be resected endoscopically. He was offered surgical exploration and resection. Preoperatively, it was felt that this lesion could be removed through a trans-duodenal local resection. At operation the tumor was found to have a broad-based attachment to the duodenal wall and a local excision was not possible (Figure 2). The patient underwent a pancreaticoduodenectomy. Surgical reconstruction was performed with a Peng end-to-end binding pancreaticojejunostomy as previously described [2] with the exception of placement of a 3.5 French plastic pediatric feeding tube as a pancreatic stent [3]. Three 10-mm Jackson-Pratt silicone drains were left at the pancreaticojejunostomy and hepaticojejunostomy anastomoses as previously described [3]. The patient advanced to a regular diet by postoperative day (POD) 6 but had amylase-rich drain output of less than 200 milliliters per day. As a result of the high-output postoperative pancreatic fistula, the patient was maintained on a low-fat diet and discharged home POD 19 with the drain that was removed in clinic POD 34.


Surgical management of giant Brunner's gland hamartoma: case report and literature review.

Stewart ZA, Hruban RH, Fishman EF, Wolfgang CL - World J Surg Oncol (2009)

Appearance of a Giant Brunner's Gland Hamartoma on Computed Tomography Scan. (a) Contrast enhanced axial image in arterial phase of acquisition demonstrates an approximately 10 cm mass in duodenum extending into the gastric antrum (white arrow) with both solid (yellow arrow) and cystic components (blue arrow) (b) coronal display shows the intraluminal nature of the mass (white arrow) and its extent as well as again defining both the solid (yellow arrow) and cystic components (blue arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2749032&req=5

Figure 1: Appearance of a Giant Brunner's Gland Hamartoma on Computed Tomography Scan. (a) Contrast enhanced axial image in arterial phase of acquisition demonstrates an approximately 10 cm mass in duodenum extending into the gastric antrum (white arrow) with both solid (yellow arrow) and cystic components (blue arrow) (b) coronal display shows the intraluminal nature of the mass (white arrow) and its extent as well as again defining both the solid (yellow arrow) and cystic components (blue arrow).
Mentions: The patient was referred to our institution and evaluated by a multidisciplinary gastrointestinal oncology team. CT imaging at that time demonstrated a massive intraluminal mass extending from the antrum through the duodenum (Figure 1). Based on this finding and previous failed attempts at endoscopic management it was decided that this tumor could not be resected endoscopically. He was offered surgical exploration and resection. Preoperatively, it was felt that this lesion could be removed through a trans-duodenal local resection. At operation the tumor was found to have a broad-based attachment to the duodenal wall and a local excision was not possible (Figure 2). The patient underwent a pancreaticoduodenectomy. Surgical reconstruction was performed with a Peng end-to-end binding pancreaticojejunostomy as previously described [2] with the exception of placement of a 3.5 French plastic pediatric feeding tube as a pancreatic stent [3]. Three 10-mm Jackson-Pratt silicone drains were left at the pancreaticojejunostomy and hepaticojejunostomy anastomoses as previously described [3]. The patient advanced to a regular diet by postoperative day (POD) 6 but had amylase-rich drain output of less than 200 milliliters per day. As a result of the high-output postoperative pancreatic fistula, the patient was maintained on a low-fat diet and discharged home POD 19 with the drain that was removed in clinic POD 34.

Bottom Line: Brunner's gland hamartomas (BGH) are uncommon benign tumors of the duodenum forming mature Brunner's glands.We report here an unusual case of a giant BGH that was not amenable to endoscopic or surgical local resection thus requiring a pancreaticoduodenectomy for extirpation.The relevant literature is discussed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Hospital, Baltimore, Maryland, USA. zstewart@jhmi.edu

ABSTRACT
Brunner's gland hamartomas (BGH) are uncommon benign tumors of the duodenum forming mature Brunner's glands. We report here an unusual case of a giant BGH that was not amenable to endoscopic or surgical local resection thus requiring a pancreaticoduodenectomy for extirpation. The relevant literature is discussed.

Show MeSH
Related in: MedlinePlus