A CASE OF GIANT BRUNNEROMA

Abstract

A case of brunneroma in the second portion of the duodenum is reported. A 59-year-old woman who visited a local practitioner because of tarry stool and general fatigue was referred to the hospital with a diagnosis of upper GI bleeding. Upper GI series revealed a pedunculate polyp in the second portion of the duodenum, and an endoscopy captured an evidence of bleeding from the duodenal polyp. A histological examination of biopsied specimens offered a suspicion of brunneroma, however, a possibility of malignancy could not be ruled out. With the most probable diagnosis of brunneroma, a surgical resection of the duodenal polyp was performed. The resected specimen was 70×36×19mm in size and was diagnosed as brunneroma pathologically, With a recent progression in technique of endoscopic therapy, case reports of endoscopic therapy for brunneroma has been increasing. Resection of giant brunneroma by endoscopic polypectomy has a risk of provoking bleeding or perforation, and it may be impossible to withdraw the resected specimen via pyloric ring. In selecting therapeutic method for giant duodenal polyp, out decision-making must be made carefully case by case, and we have not to mind selecting surgical approach if it is more appropriate.