title: Rare presentation of Brunner's gland adenoma: another differentiation in patients with recurrent "idiopathic" pancreatitis.
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.
authors.affiliation: Department of Hepatobiliary & Pancreatic, University College Hospital NHS Trust, University College London, UK. soumil_v@yahoo.com
authors.forename: Soumil
authors.initials: S
authors.lastname: Vyas
authors.forename: James R A
authors.initials: JR
authors.lastname: Skipworth
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Lytras
authors.forename: Claire
authors.initials: C
authors.lastname: Smyth
authors.forename: Anthony
authors.initials: A
authors.lastname: Mee
authors.forename: Adrian
authors.initials: A
authors.lastname: Hatfield
authors.forename: Charles
authors.initials: C
authors.lastname: Imber
authors.forename: George
authors.initials: G
authors.lastname: Webster
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014670:Ampulla of Vater / Q000473:pathology; D002011:Brunner Glands / Q000473:pathology / Q000601:surgery; D002779:Cholestasis / Q000209:etiology* / Q000601:surgery; D004379:Duodenal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D010195:Pancreatitis / Q000209:etiology* / Q000601:surgery; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult