Rare presentation of Brunner’s gland adenoma:another differentiation in patients with recurrent "idiopathic" pancreatitis

BACKGROUND:Brunner’s gland adenoma (BGA) is an unusual benign neoplasm arising from Brunner’s glands in the duodenum.When symptomatic it presents either with duodenal obstruction or bleeding.However,pancreatitis secondary to ampullary obstruction from a BGA is very rare.METHODS:A 23-year-old female presented with recurrent episodes of "idiopathic" pancreatitis.She was extensively investigated and was found to have a large polypoid BGA,intermittently obstructing the ampulla.This created a ball-valve effect causing secondary intermittent obstruction of the pancreatic duct resulting in pancreatitis.The condition was cured surgically,through transduodenal excision of the BGA.We reviewed the surgical literature pertaining to these unusual and similar causes of obstructive pancreatitis,not related to gallstones.RESULTS:BGA of the duodenum is a rare cause of pancreatitis.Extensive investigations should be carried out in all cases of unexplained pancreatitis before classifying the condition as "idiopathic".Discovery of a lesion of this nature gives an opportunity to provide a permanent surgical cure.CONCLUSIONS:BGA adds an unusual etiology for pancreatitis.All patients with pancreatitis should undergo extensive investigations before being termed "idiopathic".Surgical excision of the BGA provides a definitive curative treatment for the adenoma and pancreatitis.