Duodeno-duodenal intussusception secondary to a brunner’s gland adenoma

Abstract

Background: Duodenal intussusception is a rare complication of a Brunner’s gland adenoma with only 12 cases, including this report, reported to date. Symptoms are usually vague, diagnosis is often difficult and intussusception, due to its rarity, may mimic sinister tumours. Management usually involves a duodenotomy and excision of the adenoma.
Methods: We present a 46-year-old female who presented with features of  intermittent gastric outlet obstruction with associated anaemia.
Results: A combination of fluoroscopy, endoscopy and computed tomography revealed a duodenal intussusception with a lead  point from the 1st part of the duodenum intussuscepting into the 4th part of the duodenum. At laparotomy the Brunner’s adenoma was removed via an antrotomy.
Conclusion: A Brunner’s gland adenoma must be suspected for tumours arising in the 1st part of the duodenum. Though rare,  intussusception may mimic more sinister tumours and must be considered as an alternate diagnosis to prevent unnecessary major resections. Excision via an antrotomy rather than a duodenotomy should be considered.

Key Words: Brunner’s gland, Brunner’s gland adenoma, duodenal intussusception, duodeno-jejunal intussusception