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CC BY 4.0 · Surg J (N Y) 2022; 08(01): e14-e18
DOI: 10.1055/s-0041-1741510
Original Article

Surgical Outcome of Brunner's Gland Hamartoma: A Single-Centre Experience

Arkadeep Dhali 
1   Department of Gastrointestinal Surgery, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
,
Sukanta Ray
1   Department of Gastrointestinal Surgery, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
,
Tuhin S. Mandal
1   Department of Gastrointestinal Surgery, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
,
Somak Das
1   Department of Gastrointestinal Surgery, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
,
Ranajoy Ghosh
2   Department of Gastrointestinal Pathology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
,
Sujan Khamrui
1   Department of Gastrointestinal Surgery, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
,
Gopal K. Dhali
3   Department of Gastroenterology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
,
Avik Sarkar
4   Department of Gastrointestinal Radiology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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Abstract

Introduction Brunner's gland hamartomas (BGH) are rare benign lesions with an incidence of <0.01%, accounting for 5 to 10% of all benign tumors of the duodenum. It requires expeditious management by a multidisciplinary team. The aim of the study is to report our experience with surgery for BGH.

Methodology Data of all patients who underwent surgical intervention for duodenal polypoidal mass between August 2007 and March 2020 were retrieved from our prospectively maintained gastrointestinal (GI) surgery database. All patients whose histopathology report of the resected specimen confirmed BGH (n = 9) were included in the present study. Other pathological diagnosis like duodenal lipoma (n = 2), ganglioneuroma (n = 1), adenoma (n = 10), and adenocarcinoma (n = 4) were excluded.

Results Nine patients had confirmatory histopathological diagnosis of BGH and met our inclusion criteria. Three (33.3%) of them were men with a median age of 45 (range: 24–61) years. The median interval between onset of symptoms and diagnosis of duodenal polyp was 14 (range: 4–180) days. Five patients (55.5%) presented with upper GI hemorrhage. Three (33.3%) patients presented with abdominal pain, and one (11.1%) patient presented with episodes of bilious vomiting. Diagnostic endoscopy could detect the lesion in all (100%) patients. Contrast-enhanced computed tomography detected duodenal polypoidal lesion in five (55.5%) patients. The mean size of tumor was 4.78 ± 1.36 cm. These lesions were symptomatic in all the patients and warranted intervention. In view of failed endoscopic intervention (n = 7, 77.7%), or extramural extension of the tumor (n = 2, 22.2%), surgical intervention was considered. Most commonly performed operation was duodenal polypectomy (n = 6, 66.6%). Three postoperative complications developed in two (22.2%) patients. There was no surgery-related mortality. After a median follow-up of 60 (12 -78) months, no patient developed GI bleed or intestinal obstruction.

Conclusion In this study, the clinical profile of BGH was explored from the surgeon's point of view. Although endoscopic management is the first-line treatment, surgery plays an important role, particularly, if this fails or is not feasible. In experienced hand, surgery can be performed with acceptable perioperative morbidity and mortality and long-term satisfactory outcomes.

Keywords

Brunner's gland hamartoma - duodenal polyp - surgery - outcome

Authors' Contributions

A.D.: conception, design of the study, acquisition of the data, drafting the manuscript, and final approval of the manuscript to be submitted.


S.R.: conception, design of the study, acquisition of the data, writing, drafting the manuscript, and final approval of the manuscript to be submitted.


R.G.: acquisition of the data and final approval of the manuscript to be submitted.


S.K.: acquisition of the data and final approval of the manuscript to be submitted.


A.S.: acquisition of the data and final approval of the manuscript to be submitted.


G.K.D.: acquisition of the data and final approval of the manuscript to be submitted.


Guarantor

S.R. acts as guarantor for the article and accepts responsibility for the work.


Financial Support

None.


Declaration of Patient Consent

Informed patient consent was waived of by the ethics committee as the data were anonymized and retrospective nature of the study.


Ethical Committee Approval

This study was approved by institutional ethics committee Memo number: IPGME&R/RAC/ 266A, dated September 10, 2021)




Publication History

Received: 09 October 2021

Accepted: 02 December 2021

Article published online:
17 January 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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