Brunner's gland hyperplasia causing gastric outlet obstruction in a child: a case report

Abstract

Introduction

Brunner's gland hyperplasia (BGH) is a rare, benign proliferation of the mucus-secreting glands located predominantly in the proximal duodenum. It is most often identified incidentally during endoscopic or radiologic evaluations.

Case presentation

A 12-year-old boy presented with several weeks of intermittent postprandial abdominal pain, non-projectile vomiting, and gradually increasing upper abdominal distension. His symptoms acutely worsened, progressing to bilious vomiting and marked abdominal bloating. On physical examination, visible gastric peristalsis and hyperactive bowel sounds were observed. Abdominal radiography showed a distended stomach, and contrast-enhanced computed tomography (CT) revealed an intraluminal mass in the third part of the duodenum. Upper gastrointestinal endoscopy identified a large, pedunculated polypoid lesion obstructing more than 50 % of the duodenal lumen. Endoscopic biopsies revealed chronic inflammation without evidence of malignancy. Due to the risk of perforation and technical limitations of endoscopic resection, the patient underwent exploratory laparotomy. Intraoperatively, hypertrophic mucosal folds were identified near the duodenojejunal junction. A mucosectomy was performed via enterotomy. Histopathological examination confirmed Brunner's gland hyperplasia without any evidence of dysplasia. The postoperative course was uneventful, and the patient remains asymptomatic at 8 months of follow-up.

Conclusion

Brunner's gland hyperplasia should be included in the differential diagnosis of children who develop duodenal or gastric outlet obstruction.