Double pylorus; report of a case

Abstract

Introduction: Double pylorus (DP) is an uncommon condition characterized by the presence of bilateral (double) communication between the gastric antrum and the bulbus. DP was first reported in 1969 by Smith and Tuttle. This condition may arise (occur) as a result of a congenital abnormality or as an acquired complication of penetrating ulcer. Case report: A 60-year-old female patient who presented with dyspeptic complaints had a history of diabetes mellitus and hypertension. In the upper gastrointestinal system gastroscopy performed under sedation, an ulcer was found in the antrum. In the control gastroscopy performed after two months of medical treatment, it was observed that the ulcer in the antrum healed, but a second lumen opened from the ulcer area to the bulb. Conclusion: DP is an extremely rare condition and usually occurs as a complication of peptic ulcer. Since there is a positive correlation between DP and Helicobacter pylori (HP), diagnostic gastroscopy and detection of the presence of HP are very important in terms of treatment. PPI and, if available, HP eradication are generally recommended in medical treatment. Surgery may be required if symptoms do not improve despite medical treatment, or recurrent bleeding, obstruction, or perforation develops. Knowing the presence of DP beforehand in endoscopic procedures such as ERCP and EUS using a side-view camera is important in terms of reducing complications.

Keywords

• Double pylorus
• , gastroscopy
• Helicobacter pylori
• antrum
• ulcer

References

1. 1. Lei J, Zhou L, Liu Q, Xu C. Acquired double pylorus: Clinical and endoscopic characteristics and four-year follow-up observations. World J Gastroenterol. 2016;22:2153-8.
2. 2. Smith VM, Tuttle KW. Gastroduodenal (pyloric) band. Endoscopic findings and first reported case. Gastroenterology. 1969;56(2):331–336. doi:10.1016/S0016-5085(69)80133-2.
3. 3. Hu TH, Tsai TL, Hsu, et al. Clinical characteristics of double pylorus. Gastrointest Endosc. 2001;54:464-70.
4. 4. Oktaricha H, Miftahussurur M. Double Pylorus in Upper Gastrointestinal Bleeding. Case Rep Gastroenterol. 2021 Mar 11;15(1):332-337. doi: 10.1159/000513804. PMID: 33790722; PMCID: PMC7989772.
5. 5. Deshmukh F, Devani K, Francisco P, Merrell N. Gastroduodenal Fistula: A Rare Finding With an Atypical Presentation. Gastroenterology Res. 2020 Jun;13(3):121-124. doi: 10.14740/gr1248. Epub 2020 Jun 18. PMID: 32655730; PMCID: PMC7331852.
6. 6. Kane LA, Stanich PP, Oza VM. Double pylorus sign. Indian J Gastroenterol. 2015 Jan;34(1):92.
7. 7. Fousekis F, Aggeli P, Kotsaftis P, Pappas-Gogos G. Double Pylorus: Report of a Case With Endoscopic Follow-Up and Review of the Literature. Gastroenterology Res. 2018 Apr;11(2):154-156. doi: 10.14740/gr960w. Epub 2018 Apr 7. PMID: 29707084; PMCID: PMC5916641.
8. 8. Thapa SS, Scott J. Double pylorus. BMJ Case Rep. 2018 Sep 4;2018:bcr2018225850. doi: 10.1136/bcr-2018-225850. PMID: 30181403; PMCID: PMC6129069.

9. 9. Fattahi MR, Homayoon K, Hamidpour L. Double pylorus in a cirrhotic patient: a case report and review of the literature. Middle East J Dig Dis. 2012;4(2):130-132.
10. 10. Hatemi I, Hatemi G, Erzin YZ, Celik AF. Double pylorus in a patient with Behcet’s syndrome. Clin Exp Rheumatol. 2015;33(6 Suppl 94):S138-140.
11. 11. Yousuf M, Kameya S, Noda A, Watanabe T. A case of double pylorus accompanied by adrenal adenoma. Am J Gastroenterol. 1989;84(2):173-175.
12. 12. Lu B, Yang L. Gastric ectopic pyloric opening: an unusual case. Surg Radiol Anat. 2019 Nov;41(11):1395-1398. doi: 10.1007/s00276-019-02276-x. Epub 2019 Jul 1. PMID: 31264000; PMCID: PMC6841747.
13. 13. Yong E, Yong E, Wong JSH, Ho TWT. Acquired double pylorus. Singapore Med J. 2018 Jun;59(6):335-336. doi: 10.11622/smedj.2018073. PMID: 29974123; PMCID: PMC6024216.
14. 14. Culafic DM, Matejic OD, Dukic VS, Vukcevic MD, Kerkez MD. Spontaneous gastrojejunal fistula is a complication of gastric ulcer. World J Gastroenterol. 2007;13(3):483-485.
15. 15. Hattori A, Kawabata H, Umeda Y, Tsuboi J, Yamada R, Hamada Y, Tanaka K. Adult hypertrophic pyloric stenosis that improved by spontaneous double channel pylorus formation. JGH Open. 2020 Dec 2;5(2):317-319. doi: 10.1002/jgh3.12458. PMID: 33553675; PMCID: PMC7857292.
16. 16. Sauer B, Staritz M. [The double pylorus - a rare endoscopic finding]. Dtsch Med Wochenschr. 2012;137(8):368-370.