A Large Duodenal Growth Causing Severe Blood Loss Successfully Removed Endoscopically Without Surgery

Severe gastrointestinal bleeding is a potentially life-threatening condition, especially when the source of bleeding remains elusive despite repeated investigations. A recent case at Evercare Hospital Dhaka highlights how advanced endoscopic expertise, clinical persistence and timely decision-making can successfully treat complex conditions without the need for surgery.

A 67-year-old man, with a medical history of diabetes, hypertension and previous coronary artery bypass surgery, had been experiencing intermittent passage of black stools since 2023. From September 2025, the frequency of bleeding increased significantly, leading to profound anemia and repeated blood transfusion requirements.

He was initially evaluated at a reputed corporate hospital in Dhanmondi by a Senior Hepatologist. Both forward-viewing and side-viewing upper endoscopy, along with colonoscopy, were performed. These investigations revealed only mild gastric erosions and a reportedly enlarged papilla, with no definite source of bleeding identified. Despite medical treatment, his gastrointestinal bleeding persisted.

Subsequently, the patient was admitted to Evercare Hospital Dhaka under Senior Consultant Gastroenterologist Dr. Iqbal Murshed Kabir. On admission, his hemoglobin level was again critically low, necessitating another blood transfusion. A contrast-enhanced CT scan of the abdomen suggested the presence of a growth within the duodenum, the early part of the small intestine, raising suspicion of a missed bleeding source.

To ensure a more detailed and deeper evaluation, a repeat endoscopy was performed using a Paediatric Colonoscope, which allows wider maneuverability and deeper access beyond standard Endoscopes. This approach revealed a large, actively bleeding polypoidal growth located in the second part of the duodenum, a difficult and high-risk anatomical location.

The lesion was managed entirely through Endoscopy. After injecting Adrenaline at the base of the pedicle of the polyp, two metallic clips were applied at that site to prevent post excision bleeding. The large polyp was then meticulously resected Endoscopically using big sized snare. After excision six metallic clips were applied at excision site to achieve secure hemostasis. Despite its considerable size and challenging position, the procedure was completed safely without complications. Retrieval of the excised specimen through the upper gastrointestinal tract was technically demanding but successful.

The removed growth measured approximately 5.5 cm in size. Histopathological examination confirmed the diagnosis of a Brunner’s gland adenoma, a rare benign (non-cancerous) tumor of the duodenum known to cause occult or overt gastrointestinal bleeding.

Following the procedure, the patient recovered smoothly. He received additional blood transfusions and intravenous iron therapy, and his hemoglobin level improved steadily. At one-week follow-up, he reported no further episodes of bleeding, and laboratory tests showed his hemoglobin had returned to near-normal levels.

This case demonstrates that even large and complex duodenal lesions causing severe blood loss can be treated effectively with advanced endoscopic techniques, avoiding the risks of major surgery. At Evercare Hospital Dhaka, such world-class, minimally invasive gastrointestinal care is available locally, eliminating the need for patients to seek treatment abroad.

Author:

Dr. Iqbal Murshed Kabir

Senior Consultant

Gastrointestinal, Liver Diseases & Medicine

Evercare Hospital Dhaka