Brunner gland adenomas are hyperplastic areas of the Brunner glands within the duodenum that are greater than 1 cm. They tend to be 1-2 cm in diameter, although case reports have described tumours of up to 12 cm diameter. Where the diameter of focal hyperplasia is less than 1 cm, the term Brunner gland hyperplasia is used.
Aetiology remains obscure. Presentation occurs in the 5th and 6th decades with no sex predominance. The commonest location is on the posterior wall of the duodenum between the 1st and 2nd parts.
Brunner's gland adenoma can be categorised as symptomatic tumours and those that are asymptomatic. Symptomatic tumours can further be subdivided into haemorrhagic and obstructive tumours. In the former, gastrointestinal haemorrhage occurs because of ulceration or erosion of the tumour. Obstruction occurs when the tumour becomes significantly large enough to fill the duodenal lumen.
Symptomatic obstructive tumours may cause epigastric bloating, discomfort, vomiting or weight loss. Duodenal intussusception has been reported, but is very rare (potentially, because of the fixation of the duodenum to the posterior abdominal wall). There are also reports about patients who complained of diarrhoea because of owing to duodenal motor disturbances.
Radiographic features
Fluoroscopy
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barium studies
- nonspecific sessile or pedunculated polypoid-filling defect in the duodenal bulb
- multiple nodular filling defects (usually the 1st portion of duodenum)
- single large mass with central ulceration
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