A case of duodenal Brunner′s gland hyperplasia polyp causing hemorrhage during prescribing of antithrombotic drugs

Abstract

A 61-year-old man admitted for melena who was receaving anti coagulant and anti platlet therapy for prosthetic heart valves. Endoscopic examination revealed a large pedunculated poly with erosion on its surface, which arose from the anterior wall of the duodenal bulb. Oozing bleeding was observerd on the erosive region of the polyp. Wafarin and low dose aspirin was interrupted with heparin administration, and proton pump inhibitor and fasting were prescribed. Melena disappeared. To prevent bleeding, we performed endoscopic polypectomy without complication. The resection specimen was 40mm in maximal length. Histopathologically, remarkable Brunner's glands hyperplasia was observed in submucosal layer. The polyp was diagnosed as Brunner's gland hyperplasia polyp. Brunner's gland hyperplasia polyp was common benign tumor in the duodenum, but large region or causing gastorointestinal bleeding was rare. We review cases reported in the literature.