A rare endoscopic finding: acquired double pylorus

Congenital double pylorus with duodenal ulcer: A case report and review of the literature

Congenital double pylorus (CDP) is an extremely rare congenital disease in which both the prosopyle and apopyle are intercommunicated with the gastric antrum and duodenal bulb. The pylorus of CDP is composed of normal mucous epithelium, the lamina propria, and the muscularis mucosae. However, a few CDP operations have proved the lack of the muscularis mucosae but the existence of heterotopic pancreas tissues in the pylorus of CDP. This article reports a case of CDP complicated with duodenal ulcer in a 67-year-old man. He presented with repeated epigastric pain for 8 years and melena for 6 years, with recurrence for 3 d. He was positive for Helicobacter pylori (H. pylori) antibody. Gastroendoscopy performed 8 years ago revealed double pylorus, bile reflux gastritis, and duodenal bulbar inflammation. Gastroendoscopy performed 6 years ago revealed double pylorus with a duodenal bulbar ulcer lesion, and pathological examination suggested chronic inflammation in the duodenal bulbar mucosa, accompanied with low grade gland dysplasia. A second gastroendoscopy performed 6 years ago also revealed double pylorus with a duodenal bulbar ulcer (A2 stage). Gastroendoscopy at our hospital revealed double pylorus and pyloric canal inflammation, and pathological examination suggested pyloric canal mucosal inflammation accompanied with erosion and mild intestinal metaplasia. He was then given proton pump inhibitor therapy combined with anti-H. pylori therapy, and his symptoms were obviously improved. This case suggests that gastroendoscopy is the most direct and accurate method for the diagnosis of CDP.

Acquired double pylorus: Clinical and endoscopic characteristics and four-year follow-up observations

Double pylorus (DP), or duplication of the pylorus, is an uncommon condition that can be either congenital or acquired. Acquired DP (ADP) occurs when a peptic ulcer erodes and creates a fistula between the duodenal bulb and the distal stomach. The clinical features and endoscopic characteristics of four patients with ADP were reviewed and compared with previously reported cases. An accessory channel connects the lesser curvature of the prepyloric antrum with the duodenal bulb, and in all cases, a peptic ulcer was located in or immediately adjacent to the accessory channel. In one of the patients, the bridge between the double-channel pylorus disappeared, resulting in a single large opening and duodenal kissing ulcer after two years and three months. Finally, nonsteroidal anti-inflammatory drugs, Helicobacter pylori and other risk factors associated with ADP are assessed.

Acquired double pylorus: a case report

Double pylorus is one of the rare anomalies of the gastrointestinal tract, it can be congenital or acquired. In this case we report a case of double pylorus because of chronic peptic ulcer. Upper GI endoscopy revealed gastroduodenal fistula located on the lesser curve of the antrum, the patient's symptoms were improved rapidly by intensive antiulcer treatment.