CASE REPORT Brunner gland hamartoma (BGH) is a rare benign duodenal lesion.1,2 Most BGHs arise in the proximal duodenum, whereas lesions in the third (D3) or fourth (D4) portion are exceptional and present a blind spot for standard esophagogastroduodenoscopy (EGD).3,4 A 58-year-old man presented with melena and severe anemia (hemoglobin 8.1 g/dL). Three EGDs, including one performed during active bleeding, failed to identify a bleeding source. Contrast-enhanced computed tomography was subsequently performed, revealing a large pedunculated intraluminal mass in the distal D3 extending into D4 (Figure 1).Figure 1.: Contrast-enhanced computed tomography demonstrating a large pedunculated intraluminal mass arising from the third (D3) and extending into the fourth portion of the duodenum (D4) (yellow arrow).A push enteroscopy using a colonoscope fitted with a transparent cap (Olympus, D-201-14304, Tokyo, Japan) enabled access to the distal duodenum, revealing a large (10 × 70 mm) pedunculated polyp with superficial ulceration (Figure 2). Carbon dioxide insufflation was replaced with water immersion to prevent distal migration and facilitate specimen retrieval. Endoloop-assisted polypectomy using hot snare (Olympus PolypLoop Ligation Device, Tokyo, Japan) was performed (Figure 3). Histopathology confirmed a BGH with no dysplasia (Figure 4). Follow-up EGD at 5 months showed a healed scar. This case highlights the diagnostic value of contrast-enhanced computed tomography and demonstrates that cap-assisted enteroscopy using a colonoscope provides a minimally invasive alternative to balloon enteroscopy or surgery for distal duodenal lesions.Figure 2.: Cap-assisted enteroscopy using a colonoscope revealing a pedunculated lesion with superficial ulceration extending from D3 to D4.Figure 3.: Endoloop-assisted polypectomy of the pedunculated lesion using hot snare was performed.Figure 4.: Histopathologic examination revealing a lobulated proliferation of Brunner glands with interspersed smooth muscle fibers (hematoxylin and eosin stain, ×100 magnification).DISCLOSURES Author contributions: TT Binh: drafted the manuscript, revised the article. HH Phuong, PH Tung, DM Hung: collected clinical data, reviewed literature. NQ Dung: histopathological analysis. All authors approved the final version. TT Binh is the article guarantor. Financial disclosure: None to report. Informed consent was obtained for this case report.
Bình et al. (Sun,) studied this question.