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

Abstract

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. Complete serial sections were taken from a tissue block that included the full length of the pyloric channels, septum and ulcer. The changes showed that one channel was indeed a gastroduodenal fistula caused by intramural penetration of the pre-pyloric ulcer.Our review of the English literature found that 14 of 16 cases of double pylorus reported up to 1976 were associated with active or healed pre-pyloric or duodenal ulcer. Intriguingly, heavy salicylate intake was often reported in association with both gastroenteric and gastroduodenal fistula complicating chronic gastric ulcer.Although it remains uncertain whether salicylates and nonsteroidal anti-inflammatory drugs have a causative role in double pylorus and gastroenteric fistula, it would be of interest to know more about the medication history in the case reported by Dr Durgakeri and Mr Sarkar, especially as their patient suffered from chronic back pain. References 1. Durgakeri P, Sarkar A. Double pylorus from a chronic gastric ulcer: an interesting and rare case. ANZ J. Surg. 2015; 85: 884-6. 2. St John DJB, Carter GJ, Smith BW, Essex WB. Double pylorus: a complication of chronic gastric ulcer.