A Case of Hemorrhagic Heterotopic Brunner’s Gland of the Small Intestine

Abstract

A 7-year-old boy with asphyxia and chronic renal failure was referred to our department with melena and intense anemia. We were unable to identify the bleeding source by upper gastrointestinal endoscopy, colonoscopy, or ^99mTc-pertechnetate scintigraphy. Capsule endoscopy revealed a bleeding point in the upper part of the jejunum, and enteroscopy showed a 3-mm-diameter mass oozing with blood. He underwent enteroscopic clipping for the bleeding source, but melena persisted. Six days after clipping, we performed abdominal surgery. During laparotomy, we palpated the clip in the jejunum 3 cm from the Treitz ligament. Intraoperative enteroscopy showed that the clip was still in place on the mass, and we performed wedge resection of the jejunum, including the clip. The postoperative course was uneventful, and the patient was discharged on the 26th postoperative day. The final histopathological diagnosis was heterotopic Brunner’s gland of the small intestine. Although this disease is extremely rare, it must be included in the differential diagnosis of intestinal bleeding.