Successful Endoscopic Resection of Large Pedunculated Brunner's Gland Hamartoma Causing Gastrointestinal Bleeding Arising from the Pylorus
A 45-year-old man presented with a 4- or 5-day history of melena. He also presented nausea lasting for 10 days. His medical history was not significant for hypertension or diabetes. On physical examination, he was afebrile with normal vital signs. His abdomen was soft and nontender. Laboratory tests showed his hemoglobin to be 10.2 g/dl. Esophagogastroduodenoscopy showed a pedunculated ulcerated mass about 50 mm large arising from the pyloric ring (fig. ). We tried to pull the tumor into the stomach with a snare to prevent loss of the tumor after resection because the tumor head was located in the bulb of the duodenum. However, the tumor was too big to pass the pyloric ring. Therefore, endoscopic piecemeal mucosal resection was performed in the bulb of the duodenum for pulling out the specimen after resection; it was successfully removed by snare. A snare polypectomy was performed and secured with a clip. The lesion was a well-circumscribed mass of 48 × 32 mm, with an ulcerated surface and yellowish core (fig. ). Histological examination of the mass showed Brunner's glands with ducts separated by fibromuscular stroma (fig. ). After 5 months, follow-up esophagogastroduodenoscopy was performed; there was no evidence of recurrence.