Double Pylorus—In Evolution

Kothandaraman, Kalyanapuram R.; Kutty, Karunakaran P.; Hawken, Katherine; Barrowman, J. A.

doi:10.1097/00004836-198308000-00010

Cited by 23 publications

(19 citation statements)

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“…5 However, the majority of patients with this condition are over the age of 60 years. 9 Although it is said that ulcer symptoms disappear once the fistula is formed, 8 this patient's symptoms persisted, at least during the period of follow-up, and necessitated another course of cimetidine. However, he did not have the other complications, such as hemorrhage, obstruction, or perforation of the septum, previously reported in this condition.…”

Section: Discussionmentioning

confidence: 96%

“…Kothandaraman et al 8 found 84 cases in the world literature, while Einhorn et al 9 and Eshchar et al 10 came across only 53 and 60 cases, respectively. Whatever the highest reported number may be, it is almost certainly an underestimate because of poor case identification.…”

Section: Discussionmentioning

confidence: 98%

“…This patient was therefore treated with a common antiulcer regimen, an approach favored by most clinicians. 8,9,11 The good response to the reintroduction of cimetidine therapy obviated the need for surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

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Acquired Double Pylorus: A Case Report

Al-Mofleh

1988

Ann Saudi Med

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

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Acquired Double Pylorus: A Case Report

Al-Mofleh

1988

Ann Saudi Med

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“…In most cases, the lesion is believed to be acquired and is considered to be a complication of peptic ulcer disease, with a fistulous channel forming between the gastric antrum and the duodenal bulb (5). A congenital origin should only be considered when the orifices are of equal size, when no history of peptic ulcer disease exists, and when no radiologic or endoscopic evidence of an ulcer is found (2).…”

Section: Discussionmentioning

confidence: 99%

A Gastric Diverticulum Containing Pancreatic Tissue and Presenting as Congenital Double Pylorus: Case Report and Review of the Literature

Wolters

Nikkels²,

Zee³

et al. 2001

Journal of Pediatric Gastroenterology and Nutrition

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Double pylorus is a rare condition consisting of a double communication between the gastric antrum and the duodenal bulb. Double pylorus can occur as a congenital abnormality or as a complication of peptic ulcer disease. Although almost 100 patients with acquired double pylorus have been described (1,2), only a few patients with congenital double pylorus have been described, and, in only one patient, this anomaly was recognized in childhood (3). Herein we describe another child with congenital double pylorus, who presented with gastric outlet obstruction. CASE REPORTThe patient, a 5.5-year-old boy, was referred to us because of poor weight gain and a history of vomiting and epigastric pain since the age of 4 years. Epigastric pain occurred during the day and in the evening and was worse after eating. In the late evening, the patient usually vomited part of his previous meal. His appetite was below normal because of a constant feeling of fullness. At physical examination the child was determined to be well developed. However, height and weight, which had been 1 SD below the mean during the first few years of life, were now more than 2 SDs below the mean. The abdomen was distended without enlarged organs. Bowel sounds were normal. Findings on contrast imaging studies of the esophagus, stomach, and proximal small bowel were initially reported as normal.At endoscopy, two slitlike openings were observed at the pylorus (Fig. 1). The openings failed to dilate during examination and an Olympus XP-240 (Olympus, Tokyo, Japan) endoscope (outer diameter, 7 mm) could not be passed through either opening. The mucosae of the stomach and the esophagus were normal. Because of these findings, the contrast imaging study was repeated with special attention to the pyloric area. During this subsequent examination (Fig. 2) two barium-filled channels were seen, one cephalad to the other. Only a minimal amount of barium entered the caudally located channel on the greater curvature side. This channel ended blindly in a cystlike structure. This cystlike structure had an extrinsic mass effect on the true channel, so only a minimal amount of barium could pass into the duodenum. Subsequent pyloric ultrasonography showed a region of low echo density near the proximal duodenum.At surgery, duplication of the pyloric channel was found. The caudally located channel, on the greater curvature side of the stomach, ended blindly. A cystlike structure was found in the wall of this channel. When the duodenum was opened along its convex aspect, the cystlike structure bulged into and partly obstructed the lumen of the true pyloric channel. Truncal vagotomy, antrectomy, and gastroduodenostomy (Billroth 1) were performed. The surgical specimen consisted of the gastric antrum resected in continuity with a centimeter of duodenal cuff. After surgery, the patient was able to eat well without epigastric pain and without bouts of vomiting. In addition, after a 1-year follow-up, height and weight had returned to −1 SD.Dissection of the surgical specimen showed a d...

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“…Double pylorus is congenital or acquired with a prevalence of 0.06–0.4% 1. Four to 9% of cases are congenital 2.…”

mentioning

confidence: 99%