Brunner's gland hyperplasia causing gastric outlet obstruction in a 3-year-old child

A previously well 3-year-old girl presented with a 3-month history of progressive, non-bilious vomiting with weight loss. On examination, the abdomen was distended but non-tender; she was euvolemic. Blood tests including amylase and tissue transglutaminase IgA were normal. Abdominal radiograph and ultrasound scan (USS) were non-specific, with a distended stomach seen. A water-soluble contrast study identified delayed gastric emptying. At oesophagogastroduodenoscopy (OGD), a rosette-like mass was seen in the pylorus (figure 1). A nasogastric (NG) tube was placed to supplement nutrition. Biopsies showed chronic inflammation with no evidence of malignancy. Given the diagnostic uncertainty, laparotomy was undertaken with frozen sections. Complete excision of the pyloric mass confirmed Brunner's gland hyperplasia (BGH), and a Heineke-Mikulicz pyloroplasty was performed. Postoperative recovery was uneventful and NG feeds discontinued with resumption of oral feeding. OGD confirmed complete excision of the mass, with no evidence of recurrence. BGH is an incidental finding...
Source: Archives of Disease in Childhood - Category: Pediatrics Authors: Tags: Miscellanea Source Type: research