Double Pylorus: A Complication of Chronic Gastric Ulcer?

Abstract

A case of double pylorus with a chronic ulcer in one of the two channels is described. The patient, a middle-aged man with active rheumatoid arthritis, required partial gastrectomy to allow continued treatment of the arthritis with anti-inflammatory drugs. Detailed histological examination of the surgical specimen revealed features consistent with intramural penetration of an ulcer across the pyloric ring, resulting in a gastro-duodenal fistula. The findings provide further support for the hypothesis that the double pylorus is an acquired lesion, which occurs as an uncommon complication of chronic peptic ulcer.

Re: Double pylorus from a chronic gastric ulcer: an interesting and rare case

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Re: Double pylorus from a chronic gastric ulcer: an interesting and rare case Dr Durgakeri and Mr Sarkar provide a clear description of a case of double pylorus, 1 their findings supporting the view that most cases occur as a complication of chronic gastric ulcer.Readers may be interested in a similar case that my colleagues and I reported in 1976. 2 The patient, a 60-year-old man with severe polyarthritis, was treated at The Alfred Hospital, Melbourne, shortly before H2-receptor antagonists were introduced into clinical practice. A Polya gastrectomy was performed because of the presence of a chronic ulcer in one of the two channels, his management having been complicated by severe epigastric pain and the need for long-term treatment with sodium salicylate and indomethacin.Pathological studies on the resected specimen provided the first detailed account of the histological features of double pylorus.

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“…Readers may be interested in a similar case that my colleagues and I reported in 1976. 2 The patient, a 60-year-old man with severe polyarthritis, was treated at The Alfred Hospital, Melbourne, shortly before H2-receptor antagonists were introduced into clinical practice. A Polya gastrectomy was performed because of the presence of a chronic ulcer in one of the two channels, his management having been complicated by severe epigastric pain and the need for long-term treatment with sodium salicylate and indomethacin.…”