An unusual cause for Melena: The role of endoscopic mucosal resection in a rare case of the duodenal Brunner's gland hamartoma.

Brunner's gland hyperplasia (also referred to as adenoma or hamartoma) is a rare, benign proliferative lesion of the duodenum. Although often asymptomatic, it can occasionally present with gastrointestinal (GI) bleeding, anaemia or obstructive symptoms. We report a case of a 65-year-old woman who presented with melena and symptomatic anaemia. Upper GI (UGI) endoscopy revealed multiple sessile polyps in the duodenum, with the largest measuring 2 cm. Given her history of a recent myocardial infarction and ongoing antiplatelet therapy, an endoscopic approach was chosen. Endoscopic mucosal resection (EMR) was successfully performed after temporarily withholding antiplatelets. Histopathology confirmed Brunner's gland hamartoma with no dysplasia or malignancy. The patient's haemoglobin levels improved, and follow-up endoscopy at 1 and 6 months showed no recurrence. Brunner's gland hyperplasia is a rare but important differential for upper GI bleeding. EMR or endoscopic snare polypectomy is a safe and effective treatment modality, particularly in high-risk surgical candidates.