Double Pylorus: Report of a Case With Endoscopic Follow-Up and Review of the Literature

Abstract

Double pylorus is a rare endoscopic finding that has been reported in 0.001% to 0.4% of upper gastrointestinal endoscopies and can be either congenital or acquired. Acquired double pylorus is usually an uncommon complication of peptic ulcer that erodes and creates a fistula between the duodenal bulb and the prepyloric antrum. We describe a case of a 67-year-old man who experienced mild epigastric pain and dyspepsia over the last 6 months. The patient periodically took nonsteroidal anti-inflammatory drugs (NSAIDs) due to joint pain. Esophagogastroduodenoscopy revealed gastritis and a double pylorus. An accessory channel connected the lesser curvature of the prepyloric antrum to the duodenal bulb and the endoscope was able to be passed through both of the ducts. The Helicobacter pylori quick test proved positive. Two years later, a follow-up endoscopy showed that fistula fused with normal pylorus and there was a single large opening.

Gastroduodenal Fistula: A Rare Finding With an Atypical Presentation

“…The first cases of GDF have been seen as autopsy findings or incidental findings during surgery [10]. Patients are generally asymptomatic; however, symptoms may range from gastrointestinal bleed to abdominal pain or vomiting [5]. Our patient reported a long history of intractable vomiting associated with abdominal pain.…”

“…GDF has been associated with systemic diseases such as systemic lupus erythematosus, diabetes, and chronic obstructive pulmonary disease [11]. Medications such as NSAID and steroids have also been associated with interfering with ulcer healing and subsequent development of the fistula [5,11,12]. Our patient did not report NSAID use during the initial finding of the prepyloric antral ulcer, however, during her outpatient visits in the following year she reported daily NSAID use for abdominal pain and nausea.…”

“…They generally occur in the lesser curvature and connect the gastric antrum with the duodenal bulb [3]. While most of the previously reported cases have been seen in Asian countries, there have been case reports from other parts of the world including Greece and Peru [4][5][6]. Although Helicobacter pylori (H. pylori) and nonsteroidal anti-inflammatory drug (NSAID) use have been associated with the formation of the GDF, the actual mechanism of the condition is unknown.…”

Adult hypertrophic pyloric stenosis that improved by spontaneous double channel pylorus formation

“…On another note, double pylorus due to a gastroduodenal fistula connecting from the gastric antrum to the duodenum is a rare condition 8,9 . An acquired double pylorus is often caused by a chronic gastric ulcer that penetrates and creates a fistula with the duodenal bulb 10 .…”

Double pylorus

“…It may be congenital or acquired 1. Acquired cases can occur in gastric cancer or as a complication of chronic peptic ulcer disease leading to penetration of the peptic ulcer and the formation of a fistula between the duodenal bulb and the prepyloric antrum.…”