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Surgical Outcome of Brunner's Gland Hamartoma: A Single-Centre Experience
Introduction Brunner's gland hamartomas (BGH) are rare benign lesions with an incidence of <0.01%, accounting for 5 to 10% of all benign tumors of the duodenum. It requires expeditious management by a multidisciplinary team. The aim of the study is to report our experience with surgery for...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Thieme Medical Publishers, Inc.
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8763466/ https://www.ncbi.nlm.nih.gov/pubmed/35059497 http://dx.doi.org/10.1055/s-0041-1741510 |
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author | Dhali, Arkadeep Ray, Sukanta Mandal, Tuhin S. Das, Somak Ghosh, Ranajoy Khamrui, Sujan Dhali, Gopal K. Sarkar, Avik |
author_facet | Dhali, Arkadeep Ray, Sukanta Mandal, Tuhin S. Das, Somak Ghosh, Ranajoy Khamrui, Sujan Dhali, Gopal K. Sarkar, Avik |
author_sort | Dhali, Arkadeep |
collection | PubMed |
description | Introduction Brunner's gland hamartomas (BGH) are rare benign lesions with an incidence of <0.01%, accounting for 5 to 10% of all benign tumors of the duodenum. It requires expeditious management by a multidisciplinary team. The aim of the study is to report our experience with surgery for BGH. Methodology Data of all patients who underwent surgical intervention for duodenal polypoidal mass between August 2007 and March 2020 were retrieved from our prospectively maintained gastrointestinal (GI) surgery database. All patients whose histopathology report of the resected specimen confirmed BGH ( n = 9) were included in the present study. Other pathological diagnosis like duodenal lipoma ( n = 2), ganglioneuroma ( n = 1), adenoma ( n = 10), and adenocarcinoma ( n = 4) were excluded. Results Nine patients had confirmatory histopathological diagnosis of BGH and met our inclusion criteria. Three (33.3%) of them were men with a median age of 45 (range: 24–61) years. The median interval between onset of symptoms and diagnosis of duodenal polyp was 14 (range: 4–180) days. Five patients (55.5%) presented with upper GI hemorrhage. Three (33.3%) patients presented with abdominal pain, and one (11.1%) patient presented with episodes of bilious vomiting. Diagnostic endoscopy could detect the lesion in all (100%) patients. Contrast-enhanced computed tomography detected duodenal polypoidal lesion in five (55.5%) patients. The mean size of tumor was 4.78 ± 1.36 cm. These lesions were symptomatic in all the patients and warranted intervention. In view of failed endoscopic intervention ( n = 7, 77.7%), or extramural extension of the tumor ( n = 2, 22.2%), surgical intervention was considered. Most commonly performed operation was duodenal polypectomy ( n = 6, 66.6%). Three postoperative complications developed in two (22.2%) patients. There was no surgery-related mortality. After a median follow-up of 60 (12 -78) months, no patient developed GI bleed or intestinal obstruction. Conclusion In this study, the clinical profile of BGH was explored from the surgeon's point of view. Although endoscopic management is the first-line treatment, surgery plays an important role, particularly, if this fails or is not feasible. In experienced hand, surgery can be performed with acceptable perioperative morbidity and mortality and long-term satisfactory outcomes. |
format | Online Article Text |
id | pubmed-8763466 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Thieme Medical Publishers, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-87634662022-01-19 Surgical Outcome of Brunner's Gland Hamartoma: A Single-Centre Experience Dhali, Arkadeep Ray, Sukanta Mandal, Tuhin S. Das, Somak Ghosh, Ranajoy Khamrui, Sujan Dhali, Gopal K. Sarkar, Avik Surg J (N Y) Introduction Brunner's gland hamartomas (BGH) are rare benign lesions with an incidence of <0.01%, accounting for 5 to 10% of all benign tumors of the duodenum. It requires expeditious management by a multidisciplinary team. The aim of the study is to report our experience with surgery for BGH. Methodology Data of all patients who underwent surgical intervention for duodenal polypoidal mass between August 2007 and March 2020 were retrieved from our prospectively maintained gastrointestinal (GI) surgery database. All patients whose histopathology report of the resected specimen confirmed BGH ( n = 9) were included in the present study. Other pathological diagnosis like duodenal lipoma ( n = 2), ganglioneuroma ( n = 1), adenoma ( n = 10), and adenocarcinoma ( n = 4) were excluded. Results Nine patients had confirmatory histopathological diagnosis of BGH and met our inclusion criteria. Three (33.3%) of them were men with a median age of 45 (range: 24–61) years. The median interval between onset of symptoms and diagnosis of duodenal polyp was 14 (range: 4–180) days. Five patients (55.5%) presented with upper GI hemorrhage. Three (33.3%) patients presented with abdominal pain, and one (11.1%) patient presented with episodes of bilious vomiting. Diagnostic endoscopy could detect the lesion in all (100%) patients. Contrast-enhanced computed tomography detected duodenal polypoidal lesion in five (55.5%) patients. The mean size of tumor was 4.78 ± 1.36 cm. These lesions were symptomatic in all the patients and warranted intervention. In view of failed endoscopic intervention ( n = 7, 77.7%), or extramural extension of the tumor ( n = 2, 22.2%), surgical intervention was considered. Most commonly performed operation was duodenal polypectomy ( n = 6, 66.6%). Three postoperative complications developed in two (22.2%) patients. There was no surgery-related mortality. After a median follow-up of 60 (12 -78) months, no patient developed GI bleed or intestinal obstruction. Conclusion In this study, the clinical profile of BGH was explored from the surgeon's point of view. Although endoscopic management is the first-line treatment, surgery plays an important role, particularly, if this fails or is not feasible. In experienced hand, surgery can be performed with acceptable perioperative morbidity and mortality and long-term satisfactory outcomes. Thieme Medical Publishers, Inc. 2022-01-17 /pmc/articles/PMC8763466/ /pubmed/35059497 http://dx.doi.org/10.1055/s-0041-1741510 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ) https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Dhali, Arkadeep Ray, Sukanta Mandal, Tuhin S. Das, Somak Ghosh, Ranajoy Khamrui, Sujan Dhali, Gopal K. Sarkar, Avik Surgical Outcome of Brunner's Gland Hamartoma: A Single-Centre Experience |
title | Surgical Outcome of Brunner's Gland Hamartoma: A Single-Centre Experience |
title_full | Surgical Outcome of Brunner's Gland Hamartoma: A Single-Centre Experience |
title_fullStr | Surgical Outcome of Brunner's Gland Hamartoma: A Single-Centre Experience |
title_full_unstemmed | Surgical Outcome of Brunner's Gland Hamartoma: A Single-Centre Experience |
title_short | Surgical Outcome of Brunner's Gland Hamartoma: A Single-Centre Experience |
title_sort | surgical outcome of brunner's gland hamartoma: a single-centre experience |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8763466/ https://www.ncbi.nlm.nih.gov/pubmed/35059497 http://dx.doi.org/10.1055/s-0041-1741510 |
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