A Case of Duodenal Brunner's Gland Cyst Causing Delayed Gastric Emptying

Abstract

A 56-year-old woman was admitted to our hospital for close exploration for persistent epigastralgia and vomiting. On admission, blood tests revealed no abnormalities. An abdominal ultrasonography showed a 28-mm cystic lesion in the vicinity of the pyloric ring. Upper gastrointestinal endoscopy revealed a finding such that the tumor projected from the gastric cavity into the duodenum and almost completely occluded the duodenal bulb. A biopsy gave no malignant findings. An abdominal contrast-enhanced CT scan conducted on the second hospital day showed a slightly shrinking tumor. On the additional endoscopy conducted on the fourth hospital day, the tumor was present in the duodenal bulb, but it was depressed and reduced in size, and the occlusion was already released. Esophagogastroduodenoscopy on the nineth hospital day showed an expanding translucency in the duodenal bulb. Although no definite diagnosis was made, we performed distal gastrectomy for fear that duodenal occlusion would recur. We also confirmed from the surgical specimen that the tumor had expanded and enlarged again. The histopathological diagnosis was Brunner's gland cyst. As occlusion of the duodenal bulb with the Brunner's gland cyst is rare, we present our case with some bibliographic comments.