Peloso Andrea, Viganò Jacopo, Vanoli Alessandro, Dominioni Tommaso, Zonta Sandro, Bugada Dario, Bianchi Carlo Maria, Calabrese Francesco, Benzoni Ilaria, Maestri Marcello, Dionigi Paolo, Cobianchi Lorenzo
Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.
IRCCS Policlinico San Matteo Foundation, General Surgery 1, Piazzale Golgi, 27100, Pavia, Italy.
Ann Med Surg (Lond). 2017 Mar 29;17:43-49. doi: 10.1016/j.amsu.2017.03.034. eCollection 2017 May.
Brunner's gland hamartoma (BGH) is an infrequently encountered, benign, polypoid proliferation of Brunner's glands. Usually these lesions are asymptomatic, just only occasionally presenting with duodenal obstruction or bleeding signs and mimicking a tumoral lesion.
A 72-year-old male, referred for recurrent vomiting and epigastralgia, was investigated and all preoperative findings were suggestive of a tumour of the duodenum. During the scheduled pancreaticoduodenectomy a mass, resultant to a polyp, was palpatory felt inside the duodenum and then successfully and completely resected through a duodenotomy avoiding surgical overtreatment and connected postoperative morbidities. Histological analysis showed hyperplasia of Brunner's glands correspondent to a Brunner's gland hamartoma. BGH was undiagnosed before surgery, due to its particular sub-mucosal growth simulating an expanding process starting from the duodenum, and secondly due to unsuccessful biopsies performed during endoscopic procedure.
BGH is a rare lesion featuring, when symptomatic, obstructive or bleeding symptoms. Surgical treatment represents the gold standard approach in case of lesions that are technically impossible to remove endoscopically or in case of an undiagnosed lesion. Herein, we report a case of a patient presenting with a duodenal lesion mimicking, in all preoperative findings, a tumour of the duodenum. Duodenotomy and resection of the BGH provided a definitive cure avoiding surgical overtreatment. An intraoperative deep analysis of all surgical cases still remain crucial for a right therapeutic choice even in a new era for surgical technology. For similar intraoperative findings we recommend this technique.
布伦纳腺错构瘤（BGH）是一种罕见的布伦纳腺良性息肉样增生。通常这些病变无症状，仅偶尔表现为十二指肠梗阻或出血征象，类似肿瘤性病变。
一名72岁男性因反复呕吐和上腹痛前来就诊，经检查所有术前检查结果均提示十二指肠肿瘤。在预定的胰十二指肠切除术中，在十二指肠内可触诊到一个由息肉导致的肿块，随后通过十二指肠切开术成功完整切除，避免了手术过度治疗及相关术后并发症。组织学分析显示布伦纳腺增生，符合布伦纳腺错构瘤。BGH在手术前未被诊断出来，一是因其特殊的黏膜下生长方式，类似起源于十二指肠的扩展性病变，二是因内镜检查时活检未成功。
BGH是一种罕见病变，有症状时表现为梗阻或出血症状。对于内镜技术上无法切除的病变或未确诊的病变，手术治疗是金标准方法。在此，我们报告一例患者，其十二指肠病变在所有术前检查结果中均类似十二指肠肿瘤。十二指肠切开术及BGH切除术实现了根治，避免了手术过度治疗。即使在手术技术的新时代，对所有手术病例进行术中深入分析对于正确的治疗选择仍然至关重要。对于类似的术中发现，我们推荐这种技术。
