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.

Keywords: Double pylorus; Follow-up; Gastric ulcer; Helicobacter pylori.

Figure 1

Endoscopic view from the antrum demonstrates double pylorus. The two openings are separated by a bridge from tissue.

Figure 2

Gastroduodenal fistula has fused with normal pylorus and there is a single large opening. The remnant tissue of the bridge of the opposite sides can be easily noted.