Congenital double pyloric ostium in the adult

Abstract

Duplication of the pylorus, an extremely rare congenital anomaly of the stomach, consists of two openings connecting the antrum of the stomach to the duodenal bulb. Approximately 70 cases of double pylorus have been described in the literature, most of which are associated with the presence of chronic peptic ulcers, thus indicating an acquired origin of the condition. We report a case of congenital double pylorus in a 64-year-old man who complained about mild postprandial epigastric discomfort and nausea of approximately 3 months' duration. Endoscopic examination of the stomach showed a double pyloric ostium connecting the stomach to the duodenum. No signs of acute or chronic peptic ulcer were noted. A biopsy was taken from the region between the two openings, which showed normal mucosa and a muscularis mucosae layer. Apart from a mild gastritis, no other pathology (chronic peptic ulcer, ulcerated malignancy) suggesting an acquired origin of the double pylorus was observed. Therefore, the case was considered to be congenital in origin. The patient was successfully treated conservatively with antacids and gastrokinetics.

A Rare Gastric Outlet Anomaly: Pyloric Ostium on Incissura Angularis

“…A congenital origin may be assumed if the diagnosis is made in early childhood; the histologic examination shows the presence of mucosa, lamina propria, and muscularis mucosae; or if surgical intervention, chronic penetrating ulcer, or chronic gastritis history is absent [5]. When peptic ulcer disease or gastric inflammation is the cause of gastric outlet anomaly, it generally presents as pyloric stenosis or double pylorus.…”

“…In pediatric studies, reported incidence is estimated to be 1 in 20,000-40,000 births, but incomplete obstructive lesions such as duodenal webs are even rarer, accounting for only 2% of these defects [6,7]. Although various rare types of gastric outlet anomalies including pyloric agenesis, pyloric stenosis, pyloric webs, duodenal webs, and Springer annular pancreas have been reported [1][2][3][4][5], in the English literature, we could not find any gastric outlet anomaly such as our patient's. In this case it was also interesting to see that with such an anomaly major gastric complaints were not present until the sixth decade.…”

“…In general, there are certain major symptoms that lead to referral for examination of the upper alimentary tract, but the relative importance of each symptom varies depending on the type of anomaly and the patient's age. The delayed presentation of these anomalies in adulthood is difficult to explain, but progressive loss of compensatory peristaltic action to overcome the pyloric or duodenal narrowing is the usually suggested reason [5]. In this case report, we present an example of adult-onset congenital pyloric outlet anomaly in a 60-year-old man with mild postprandial epigastric discomfort of approximately 3 months' duration.…”

Der Doppelpylorus – ein seltener endoskopischer Befund

“…Die Schleimhaut ist glatt und reizlos, und das separierende Gewebe hat eher den Charakter eines runden Stranges oder Bandes [10]. Komplikationen treten hierbei kaum auf und die Patienten sind mit wenigen Ausnahmen [5,10] beschwerdefrei. In einem Fall war der Doppelpylorus mit einer Achalasie assoziiert [4].…”

A rare endoscopic finding: acquired double pylorus

“…Frequently, it is a complication of peptic ulcer disease, resulting from penetration of the peptic ulcer and the creation of a fistula between the duodenal bulb and the prepyloric antrum. Occasionally it may be congenital or secondary to gastric carcinoma [3,4]. The location of the second duct is commonly in the lesser curvature of the gastric antrum, near the anatomic pylorus.…”