A giant Brunner’s gland hamartoma: a rare cause of upper gastrointestinal bleeding

A 78-year-old man was admitted with melena, anemia and hypotension. Upper endoscopy revealed a giant lobulated and pedunculated lesion of the duodenal bulb with an ulcerated area (Fig.1A-C). Biopsies performed during upper endoscopy revealed foveolar epithelium with no dysplasia. Abdominal CT showed a nodular lesion protruding to the duodenal lumen with a diameter of approximately 40mm (Fig.2A). Giving the anemia, with recurrent transfusion need, endoscopic resection was proposed. During the intervention an endoloop was deployed at the base of the pedicle and a hot snare polypectomy was successfully performed without complications (Fig.1D). The patient was discharged after the procedure, asymptomatic, with no evidence of bleeding recurrence. Histology (Fig.2B) was consistent with Brunner’s gland hamartoma (BGH).