Upper gastrointestinal bleeding: an uncommon manifestation of Brunner's gland hamartoma

Case report Upper gastrointestinal bleeding is one of the most common emergencies in our clinical practice. We present the case of a 53-year-old woman, an active smoker on chronic treatment for anxiety as her only relevant history, who presented to the emergency department with melena and hematemesis without hemodynamic instability [1] [2] [3].

Urgent upper gastrointestinal endoscopy revealed a 2 cm ulcerated lesion with a subepithelial appearance on the mesenteric edge of the second portion of the duodenum, proximal to the major papilla, which was biopsied. A CT scan of the abdomen and pelvis showed only hepatic hemangiomas in segments II and IV. The study was completed with an endoscopic ultrasound (EUS), which showed a rounded 18 mm lesion in the duodenal wall limited to the submucosal layer (3rd layer), hyperechoic with a small central anechoic focus, likely representing a necrotic or cystic area. The subepithelial lesion was resected en bloc with a duodenoscope in a single fragment. The scar was closed with a hemoclip, and the sample was sent for histopathological study. The report indicated a Brunner’s gland hamartoma. The patient was discharged without new bleeding episodes.

Conclusion Brunner’s gland hamartomas are a rare cause of upper gastrointestinal bleeding. Diagnosis can be challenging with upper gastrointestinal endoscopy and superficial biopsies. EUS is the best imaging technique to characterize these lesions, as it establishes precise location within the GI wall and provides ultrasonographic details that guide differential diagnosis and treatment. The prognosis after resection is generally excellent.

Publication History

Article published online:
27 March 2025

• References

• 1 Deprez PH, Moons LMG, OʼToole D. et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline Endoscopy. 2022; 54.
• 2 Levine J.A., Burgart L.J, Batts K.P.. et al. Brunner's gland hamartomas: clinical presentation and pathological features of 27 cases. Am J Gastroenterol 1995; 90: 290-294
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