P2079 - Brunners Gland Hamartoma Presenting as an Upper GI Bleed

Andrew John Cruz, BS¹, Abebe Muraga, MD¹, Rajan Amin, MD², Jose Aponte-Pieras, MD^3
1Kirk Kerkorian School of Medicine, Las Vegas, NV; ²University of Nevada, Las Vegas, Las Vegas, NV; ³Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV

Introduction: Brunner’s glands are branched mucin-secreting glands located in the mucosal or submucosal layers of the proximal duodenum, and they maintain the integrity of duodenal mucosal epithelium by secreting alkaline substances to oppose the gastric acid secretion. Brunner’s gland Hamartoma is a rare benign tumor that has been associated with malignant transformation. Here we present a case of Brunner’s gland Hamartoma (BGH) presenting with gastrointestinal bleeding.

Case Description/Methods: A 66-year-old male with hyperlipidemia and alcohol use disorder presented with one day history of melena and coffee-ground emesis. Physical exam was unremarkable. Laboratory workup revealed Hgb of 12.3, MCV 88, and BUN of 39 on admission. CT abdomen was unremarkable. Patient underwent endoscopy which revealed a 4 cm pedunculated polyp with a thick stalk along the anterior wall of the duodenal bulb. Polypectomy with hot snare was followed by hemostasis with cautery and hemospray. Pathology revealed prominence of Brunner’s glands and with areas of lobulated proliferation of glandular structures, consistent with Brunner’s Gland Hamartoma.

Discussion: The exact etiology of Brunner’s gland hyperplasia remains unclear, but it is believed that these hamartomas represent embryonic dysplasia of the duodenum. It has also been hypothesized that there is a link to chronic mucosal injury, Helicobacter pylori infection, gastric hyperacidity, and chronic pancreatitis. The clinical manifestations of BGH are nonspecific, including gastrointestinal bleeding, iron deficiency anemia, abdominal pain, nausea or vomiting. Endoscopic or surgical interventions can be used to treat bleeding or obstruction caused by these hamartomas; recurrence is rare after resection. This case reports on a patient with Brunner’s gland hamartoma who presented with upper GI bleeding and was successfully treated with polypectomy, cautery and hemospray.


Disclosures:


Andrew John Cruz, BS¹, Abebe Muraga, MD¹, Rajan Amin, MD², Jose Aponte-Pieras, MD³. P2079 - Brunners Gland Hamartoma Presenting as an Upper GI Bleed, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.