Brunner's gland adenomas: clinical presentation and surgical management.

Tumors of the Brunner's glands are rare, and the etiology remains obscure. Bleeding is the most common presenting symptom and may be occult or exsanguinating. Gastric outlet or duodenal obstruction may also occur. Often there is a history of preexisting nonspecific upper gastrointestinal symptoms, or the adenoma may be an incidental postmortem finding. Although contrast studies usually suggest the diagnosis confirmation requires endoscopy or operation. Resection is the preferred therapy, but bypass of the lesion has been done becaue the adenomas are not considered premalignant. Gastroduodenoscopy may facilitate definitive management. Our experience in managing three patients with Brunner's gland adenomas, including a patient with life-threatening upper gastrointestinal hemorrhage from an ulcerated Brunner's gland tumor, is cited.