Role of computed tomography in the diagnosis of Brunner gland hamartoma.

Brunner gland hamartoma is an uncommon lesion that is usually located in the first portion of the duodenum. Its origin is submucosal and it has a potential risk for bleeding. There are no specific symptoms nor are there any endoscopic images to aid in the initial diagnosis. Endoscopic ultrasound has been suggested as the gold standard method due to its capability to identify this pathology. We present a clinical case with CT diagnosis and its unique radiological characteristics, and we review the literature published to date. The patient is a 40-year-oldmalewith no history of interest who came to our hospital due to syncope and melenas. He had had no previous episodes of gastrointestinal bleeding until 48 h before, when the melenas had begun. The patient was haemodynamically stable, and the abdomen was soft and non-painful. Lab workup showed haemoglobin 10.3 g/dL, HCT 29.6%, 13 400 leukocytes and 81% PMN; the remaining haemogram and biochemistry levels were normal. Gastroscopy revealed a polypoid lesion in the superior duodenal knee; gastrointestinal stromal tumour was ruled out, and no signs of previous bleeding were observed. We requested an abdominal CT. The results reported themass was a polypoid lesionmeasuring 3 cm 2.6 cm in the second portion of the duodenum, which had a 3 cm pedicle that was implanted in the posterior side of the duodenal bulb. The lesion presented heterogenous uptake, with a peculiar presence of areas of fatty density in its interior, which provided a probable diagnosis of Brunner gland hamartoma (Figs. 1 and 2). We performed gastroscopy with polypectomy and haemostatic control of the pedicle with adrenalin and endoclips. The pathology study defined the lesion as a mucosal– submucosal mass of hyperplastic Brunner glands and observed proliferated hyperplastic glandular lobules with cystic dilatations, separated by fibrous tissue, adipocytes and smooth muscle fibres. These findings were compatible with Brunner gland hamartoma. The patient was discharged. He continues to be asymptomatic, and endoscopic follow-up studies have shown good progress. The Brunner glands are acinar structures that are mainly situated in the first portion of the duodenum, which diminish c i r e s p . 2 0 1 6 ; 9 4 ( 1 ) : e 1 7 – e 1 9