ACG Case Reports Journal · 5 authors, 3 centres
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A single-patient case report describes the first documented recurrence of Brunner gland adenocarcinoma 6 years after curative surgical resection, diagnosed via small bowel enteroscopy in a 62-year-old man, who ultimately died from complications related to gastrointestinal bleeding.
This case report describes a 62-year-old man with a prior partial duodenectomy and Billroth II gastrojejunostomy for Brunner gland adenocarcinoma (BGA) who presented 6 years later with hematochezia and anemia. Bidirectional endoscopy was negative, but small bowel enteroscopy identified a 25 mm polypoid mass in the second portion of the duodenum; histology confirmed recurrent BGA with high-grade dysplasia. Two weeks after discharge the patient developed melena from a gastrojejunostomy anastomotic ulcer refractory to endoscopic hemostasis, leading to hemodynamic instability, respiratory failure, and death. The authors note this is the first reported case of BGA recurrence after curative resection and emphasize that Billroth II altered anatomy can complicate endoscopic detection of bleeding sources. Limitations include the single-case design, loss to follow-up during the surveillance interval, and the absence of microsatellite instability testing.
