Portal de Periódicos da CAPES

Hyperplasia of Brunner's Glands

1953; Radiological Society of North America; Volume: 60; Issue: 6 Linguagem: Inglês

10.1148/60.6.814

1527-1315

Gerald D. Dodd, James S. Fishler, Oakley K. Park,

Biliary and Gastrointestinal Fistulas

Articles dealing with the roentgen diagnosis of diseases of the duodenum contain few references to the duodenal glands of Brunner despite the frequency with which this area is subjected to examination. Golden in 1928 (9) first reported the roentgenologic detection of solitary adenomata and subsequently stated that they are the most common benign tumors of the duodenum (8). Their apparent frequency is further emphasized by the series of other authors (1, 4, 10). The possibility of malignant degeneration of these adenomata has also been considered (1, 12, 14). Although hyperplasia of Brunner's glands had been described by pathologic anatomists as early as 1876 (13), it was not until 1941 that a comprehensive survey of the pathologic processes common to these structures was published by Robertson (12). On the basis of his descriptions, it is apparent that the gross features of hyperplasia as well as those of adenomata should be demonstrable radiographically. The clinical detection of such lesions was unknown, however, until 1948, when Erb and Johnson (3) reported the case of a 36-year-old male whose chief complaint was mild diarrhea of one year duration. A high gastric acidity and a persistent roentgen demonstration of small opacities confined to the duodenal cap and proximal portion of the descending duodenum were the two impressive preoperative findings. A tentative diagnosis of duodenal polyposis was made. At operation, a cobblestone effect of the duodenal mucosa was found, and pathologic examination revealed the basic lesion to be a hyperplasia of Brunner's glands. Erb and Johnson speculated that the hyperplasia represented a possible protective mechanism against high gastric acidity. This possible relationship was emphasized by the development of a stomal ulcer following extirpation of the duodenal bulb and pylorus with end-to-end anastomosis of the duodenal loop and gastric antrum. A subsequent subtotal gastric resection with removal of the acid-producing portion of the stomach was necessary. Within the past year we have observed 2 similar cases, one proved by biopsy. In both instances the diagnosis was initially advanced by roentgen examination on the basis of Erb and Johnson's work. It is the purpose of the present report toy summarize these cases and briefly discuss the implications of such a diagnosis. Case I: A 35-year-old white Warrant Officer was referred for upper gastrointestinal studies on May 10, 1951, because of intermittent epigastric discomfort of several years duration. This consisted of bloating and belching and an aching sensation extending across the mid-epigastrium. The discomfort usually appeared shortly after meals and was described as “gnawing” in character. Some intolerance to fried foods was noted, with some relief obtained from antacids. Occasionally mild bouts of diarrhea and morning nausea were present but there was no history of emesis or melena.