Gastric carcinoma presenting as double-channel pylorus on upper gastrointestinal series

Abstract

A double-channel pylorus or gastroduodenal fistula is a rare entity frequently acquired in association with penetrating peptic ulcer disease. The diagnosis is made by upper gastrointestinal series or by endoscopy. We report a 59-year-old man who presented with gastric outlet obstruction whose upper gastrointestinal series was typical of benign peptic ulcer disease demonstrating antral ulcers and a double-channel pylorus. At operation, gastric carcinoma infiltrating the pyloric channel and dividing it into two lumens was found. No gastroduodenal fistula was found. The "gastroduodenal fistula" on upper gastrointestinal series had been created by gastric carcinoma protruding into the pyloric channel and dividing the barium flow into two streams. One can no longer assume that a double-channel pylorus is due to benign ulcer disease.

Double Pylorus: an Unusual Endoscopic Finding

“…In contrast swallow studies, double pylorus appears as two channels of barium separated by a smooth radiolucent band of soft tissue. At endoscopy, the gastric antrum may appear normal (as in the present two cases), inflamed, or ulcerated [4]. The fistula may vary in size from a few millimeters to several centimeters, and usually extends from the lesser curvature of the stomach to the superior aspect of the duodenal bulb [5].…”

Clinical characteristics of double pylorus

“…The differential diagnosis of DP is not extensive, although possible confusion with antral carcinoma has been mentioned. 12,13 DP may be either congenital or acquired. [14][15][16] DP arose in most cases in the present series as a complication of peptic ulcer and thus these cases were considered to be of the acquired type.…”