Background Brunner’s gland is a gland in the submucosa of the duodenum and its hyperplasia rarely presents with any symptoms. We present an unusual case of a 3½ year old child with gastric outlet obstruction due to Brunner’s gland hyperplasia.
Case Presentation A 3½ year old girl presented with a 3 month history of persistent non-bilious and non-projectile vomiting with weight loss. Physical examination revealed an alert, comfortable but quiet child who was not clinically dehydrated. The abdomen was distended, however soft, non-tender with normal bowel sounds and no palpable masses.
Investigations Blood tests on admission were normal except for hypochloraemia. Abdominal x-ray showed a mottled appearance in the stomach area with normal bowel gas pattern.
A water soluble contrast study demonstrated a large stomach.
Endoscopy identified a rosette shaped mass upon entering the pylorus. An ultrasound abdomen showed hypoechoic well defined area in the anterior wall in the pyloric region. A contrast CT showed gastric pyloric thickening with a grossly dilated stomach.
Biopsies of subpyloric lymph nodes showed inflammatory changes. Histology of the pyloric mass showed Brunner gland hyperplasia and distended duct with surrounding histiocytic and giant cell reaction with no evidence of malignancy.
Management The initial management of the patient was aimed at minimising the patient’s symptoms and aiding her nutritional needs with dietician input. She had laparoscopy with lymph node biopsies and was started on parenteral nutrition postoperatively. She then underwent pyloroplasty, was started on nasojejunal feeds.
Outcome and follow up She gradually established oral feeds and made an uneventful recovery. She was reviewed in the clinic and was managing well and gaining weight.
Discussion The main function of Brunner’s gland is to secrete mucus to protect the duodenal lining from the acid secreted in the stomach. The clinical manifestations of Brunner’s gland hyperplasia are usually nonspecific, such as epigastric pain, abdominal distension and rarely bleeding, bowel obstruction and duodenal intussusception. Endoscopic or surgical resection is the treatment of choice when Brunner’s gland hyperplasia is symptomatic or causes any complications.
Learning points Brunners gland hyperplasia is a rare cause of gastric outlet obstruction in children
Endoscopic resection or surgical resection is the treatment of choice
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