BACKGROUND:

Duodenal adenocarcinoma is a small percentage of gastrointestinal neoplasms, around 0.5%, and its treatment is based on resection of the tumor, classically by pancreaticoduodenectomy. In recent years, however, segmental resections of duodenal lesions, that do not involve the second portion or the periampullary region, have gained relevance with good surgical and oncological outcomes as well as the benefit of avoiding surgeries that can result in high morbidity and mortality.

AIMS:

To report a case of an elderly female patient with malignant neoplastic lesion in the third and fourth duodenal portion, non-obstructive, submitted to surgical treatment.

METHODS:

The technical option was the resection of the distal duodenum and proximal jejunum with preservation of the pancreas and reconstruction with side-to-side duodenojejunal anastomosis.

RESULTS:

The evolution was satisfactory and the surgical margins were free of neoplasia.

CONCLUSIONS:

Segmental resections of the duodenum are feasible and safe, offering the benefit of preventing complications of pancreaticoduodenectomies.

INTRODUCTION

Brunner gland adenoma (Brunerroma or hamartoma) is a rare, benign lesion of the Brunner's glands, accounting for 10.6% of benign duodenal tumors¹⁰. It is predominantly seen in the 5^th to 6^th decades and with no gender predilection¹³. It is often an incidental finding during esophagogastroduodenoscopy or imaging studies. In symptomatic patients, clinical manifestations include gastrointestinal bleeding, duodenal obstruction, abdominal pain, ampullary obstruction, or intussusception^8,9. Given their potential to be mistaken as cancer, it is important to consider it in the differential diagnosis of duodenal masses¹⁴. As there have been reports of focal cellular atypia and adenocarcinoma within the lesion, resection, whether endoscopic or surgical is recommended for suspected Brunneromas³.

We report here a case of Brunneroma, which presented as gastrointestinal stromal tumor (GIST) with intussusception on radiological and endoscopic studies and brief review of literature.