Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9670
Peer-review started: June 6, 2021
First decision: June 25, 2021
Revised: August 26, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: November 6, 2021
Brunner’s gland hyperplasia (BGH) is a rare benign lesion of the duodenum. Lipomatous pseudohypertrophy (LiPH) of the pancreas is an extremely rare disease. Because each condition is rare, the probability of purely coincidental coexistence of both conditions is extremely low.
We report a 26-year-old man presenting to our hospital with symptoms of recurrent upper gastrointestinal bleeding. Upper gastrointestinal endoscopy showed a huge pedunculated polypoid lesion in the duodenum with bleeding at the base of the lesion. Histopathological examination of the duodenal biopsy specimens showed BGH. Besides, abdominal computed tomography and magnetic resonance imaging revealed marked fat replacement over the entire pancreas, confirmed by histopathological evaluation on percutaneous pancreatic biopsies. Based on the radiological and histological findings, LiPH of the pancreas and BGH were diagnosed. The patient refused any surgical intervention. Therefore, he was managed with supportive treatment. The patient’s symptoms improved and there was no further bleeding.
This is the first well-documented case showing the coexistence of LiPH of the pancreas and BGH.
Core Tip: Brunner’s gland hyperplasia (BGH) and lipomatous pseudohypertrophy (LiPH) of the pancreas are rare diseases. We present a case with coexisting LiPH of the pancreas and a huge pedunculated BGH of the duodenum that presented with upper gastrointestinal bleeding. Esophagogastroduodenoscopy revealed a large submucosal mass along the duodenum with central ulceration, and radiological examination showed marked thickening of the duodenal walls and fatty replacement over the entire pancreatic parenchyma. Diagnoses of BGH and LiPH were confirmed by histological evaluations. Although rare, BGH can cause gastrointestinal bleeding. Furthermore, this case highlights the usefulness of combined esophagogastroduodenoscopy and radiological examinations in patients with melena.