Laparoscopic antrectomy for a proximal duodenal Brunner gland hamartoma.
BACKGROUND
Adenoma is the most common cause of duodenal polyps, while hamartomas are very rare. We present a patient with a preoperative histology proved diagnosis of isolated duodenal tubulovillous adenomatous polyp with high-grade dysplasia for whom we performed laparoscopic antrectomy.


METHODS
The patient was a 56-year-old male with vague upper abdominal pain. Investigations revealed a 3-cm x 3-cm mass arising from the duodenal mucosa with no evidence of extraserosal spread. Histopathology documented an adenomatous polyp with high-grade dysplasia, so a laparoscopic antrectomy was performed.


RESULTS
The patient had an uneventful postoperative period, requiring only 2 doses of parenteral analgesics. He was discharged on the seventh postoperative day. The final histopathological findings were consistent with benign hamartoma. No recurrence has been reported after 14 months of follow-up with endoscopy.


CONCLUSIONS
Many procedures have been described for polyps, such as endoscopic excision, duodenectomy, pancreatoduodenectomy, and laparoscopic polyp excision. In our patient, the decision to perform duodenectomy was based on the preoperative findings of a sessile tubulovillous adenomatous polyp with high-grade dysplasia. Histologically, the 2 entities can be identical, especially with the small tissue volume obtained from endoscopic biopsy.


CONCLUSIONS
Given these observations, antrectomy was probably ideal, because endoscopic excision would have been inadequate and even dangerous while pancreatoduodenectomy would have been too radical.
GEM Hospital & Postgraduate Institute, 45-A Pankaja Mill Road, Coimbatore 641045, INDIA. drcp@gemhospital.net
Chinnusamy
C
Palanivelu
Muthukumaran
M
Rangarajan
Priyadarshan Anand
PA
Jategaonkar
Shankar
S
Annapoorni
Hari
H
Prasad
D002011:Brunner Glands / Q000473:pathology / Q000601:surgery*; D003937:Diagnosis, Differential; D004378:Duodenal Diseases / Q000175:diagnosis / Q000601:surgery*; D006222:Hamartoma / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged