Laparoscopic Resection of Duodenal Giant Brunner’s Gland Hamartoma

Sergio Carandina, MD, Perrine Mathonet, MD, Guy Bernard Cadière, MD, PhD

Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Paris XIII University-University Hospitals of Paris Seine Saint-Denis, Paris, France (Dr. Carandina). Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium (Drs. Mathonet, Cadière).

ABSTRACT

Background: Brunner’s gland hamartoma (BGH) is a rare, proliferative entity arising from alkaline-secreting glands located mainly in the duodenum. In most cases, BGH develops as a polypoid pedunculated lesion of 1 to 2 cm in diameter, whereas in a few cases, the so-called “giant BGH” can reach 12 cm in size. Removal of BGH is required in symptomatic patients, and treatment options include the endoscopic or surgical approach.

Case Report: We report the case of a 33-year-old woman affected by a symptomatic giant BGH. Laparoscopic local surgery was planned. With the patient under general anesthesia, a laparoscopic Kocher maneuver and a polypectomy via duodenectomy were performed. Then the duodenotomy was closed with a horizontal manual suture. The operative time was 75 minutes and blood loss was 40 mL.

Results: The patient made an uneventful recovery and is well at a one-year follow-up. Pathologic examination results showed a 10 2.5-cm BGH without signs of malignancy or dysplasia.

Conclusion: Laparoscopic transduodenal resection can be considered a safe and feasible procedure for large polyps that are not candidates for endoscopic resection.

Key Words: Brunner’s gland hamartoma, Duodenal polyp, Laparoscopy, Excision.

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