Brunner’s gland hamartoma in worsening GERD: A rare case report

Abstract

Background

Brunner’s gland hamartoma is an uncommon, benign duodenal tumor that arises from the Brunner’s glands. It is classified as hyperplasia or hamartoma based on its size. Symptoms include dyspepsia, nausea or postprandial epigastric pain, anemia, gastrointestinal bleed and small bowel obstruction. Its definitive diagnosis is by histopathological findings. We report an unusual case of Brunner’s gland hamartoma presenting as worsening epigastric pain and reflux in a patient with chronic controlled gastroesophageal reflux disease.

Case presentation

A 48-years-old female with a history of chronic gastroesophageal reflux disease of 15 years duration on omeprazole, and stage A esophagitis of 4 years duration, presented for worsening epigastric pain and reflux for the past 6 months, with frequent regurgitation of acidic fluid, and postprandial nausea but no vomiting. Esophagogastroduodenoscopy was performed and revealed the presence of a large duodenal polyp. Pathology results were suggestive of Brunner’s gland hamartoma.

Conclusion

This article reports a case of Brunner’s gland hamartoma, that is exacerbating a previously controlled gastroesophageal reflux disease, and found incidentally on esophagogastroduodenoscopy. This report highlights the masking of Brunner’s hamartoma by chronic gastroesophageal reflux disease. It also raises awareness of considering this condition as a differential diagnosis in patient with long standing reflux disease that worsens with time.