A large Brunner’s gland adenoma: an unusual cause of gastrointestinal bleeding Case report and literature review Ann. Ital. Chir., 81, 2, 2010 147 Ann. Ital. Chir., 2010 81: 147-151 Introduction Although the small intestine constitutes 75% of the gas- trointestinal tract, tumors are extremely rare (about 5%). Duodenum representing only 4% of the small intestine has a relatively high proportion of all the tumors as com- pared to the jejunum and ileum. Adenomas are the most common duodenal tumors including adenomatous polyps and Brunner adenoma 1-3 . Brunner’s glands, des- cribed by the anatomist Brunner in 1688, are submu- cosal mucin-secreting glands. Their localization are in the duodenal bulb and progressively decrease in size and number in the distal portion 4,5 . Brunner’s glands secre- te an alkaline fluid composed of mucin which protect the duodenal epithelium from the acid chime of the sto- mach 6-9 . Brunner’s gland adenoma, also known as Brunneroma or polypoid hamartoma, is a rare, benign tumor arising from the Brunner’s glands that exceptio- nally maye volve towards a malignant transformation 10- 12 . These lesions, firstly described by Curveilheir in 1835, manifest occasionally as a rare cause of duodenal obs- truction or upper gastriontestinal hemorrhage, and requi- re surgical treatment 6,8,13,14 . The present is a case of large Brunner’s gland adenoma resected by surgery with literature review. Aetiology, cli- nical picture, differential diagnosis and treatment of this rare tumor are discussed. Case report A 38-year-old female referred about six month a severe anemia was required blood transfusions. Endoscopic exa- mination revealed ulcer in the duodenal bulb treated by antacids and H2 blockers. When the patient was admit- ted to our Department of Surgical Sciences vital sign were normal but severe anaemia and vague epigastric dis- comfort after meals without nausea, vomiting, epigas- tralgia, melena or obstructive symptoms was reported. On admission she received blood transfusions, Hb 6,8 g/dl (normal 12-16 g/dl). She denied weight loss and Pervenuto in Redazione Febbraio 2010. Accettato per la pubblicazione Aprile 2010. Correspondence to: Dr. Daniele Pironi, via Italo Carlo Falbo 10, 00157 Rome, Italy (e-mail danielepironi@virgilio.it) Daniele Pironi, Maurizio Vendettuoli, Gabriele La Gioia, Stefano Arcieri, Angelo Filippini Department of Surgical Sciences, Sapienza University, Rome, Italy A large Brunner’s gland adenoma:un unusual cause of gastrointestinal bleeding. Case report and literature review. Brunner’s gland adenoma is a rare benign tumour of the duodenum. His most common location is the posterior wall of the duodenum near the junction of its first and second portion. It is usually small and asymptomatic often discove- red incidentally with upper gastrointestinal endoscopy, but sometimes may become large causing symptoms (haemorrhage or intestinal obstruction). We report a rare case of a very large Brunner’s gland adenoma in a 38-year-old female pre- senting with severe anaemia but without obstructive symptoms and detected by ultrasonography. The tumour was mana- ged by surgical removal and during a six month follow-up the patient reimaned symptom-free without any recurrence. The literature on Brunner’s gland adenoma is reviewed. KEY WORDS: Brunner’s gland adenoma, Large Brunneroma Surgical excision, Upper gastrointestinal bleeding.