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Rare presentation of Brunner-s gland adenoma: another differentiation in patients with recurrent "idiopathic" pancreatitis |
Soumil Vyas, James RA Skipworth, Dimitrios Lytras, Claire Smyth, Anthony Mee, Adrian Hatfield, Charles Imber and George Webster |
London, UK
Author Affiliations: Department of Hepatobiliary & Pancreatic Surgery (Vyas S, Skipworth JRA, Lytras D and Imber C) and Department of Gastroenterology (Smyth C, Hatfield A and Webster G), University College London Hospital NHS Trust, London, NW1 2BU, UK; Department of Gastroenterology, Royal Berkshire Hospital NHS Trust, Reading, RG1 5AN, UK (Mee A)
Corresponding Author: Soumil Vyas, MD, Division of Hepatobiliary & Pancreatic Surgery, University College Hospital, 2B Maple House, 25 Grafton Way, London, WC1E 5DB, UK (Tel: 44-207-380-9202; Fax: 44-207- 380-9312; Email: soumil_v@yahoo.com) |
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Abstract BACKGROUND: Brunner s gland adenoma (BGA) is an unusual benign neoplasm arising from Brunner s glands in the duodenum. When symptomatic it presents either with duodenal obstruction or bleeding. However, pancreatitis secondary to ampullary obstruction from a BGA is very rare.
METHODS: A 23-year-old female presented with recurrent episodes of "idiopathic" pancreatitis. She was extensively investigated and was found to have a large polypoid BGA, intermittently obstructing the ampulla. This created a ball-valve effect causing secondary intermittent obstruction of the pancreatic duct resulting in pancreatitis. The condition was cured surgically, through transduodenal excision of the BGA. We reviewed the surgical literature pertaining to these unusual and similar causes of obstructive pancreatitis, not related to gallstones.
RESULTS: BGA of the duodenum is a rare cause of pancreatitis. Extensive investigations should be carried out in all cases of unexplained pancreatitis before classifying the condition as "idiopathic". Discovery of a lesion of this nature gives an opportunity to provide a permanent surgical cure.
CONCLUSIONS: BGA adds an unusual etiology for pancreatitis. All patients with pancreatitis should undergo extensive investigations before being termed "idiopathic". Surgical excision of the BGA provides a definitive curative treatment for the adenoma and pancreatitis.
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