Acquired double pylorus: An unusual complication of duodenal ulcer

A 52-year-old man presented with epigastric pain and melena. He had a history of alcohol and tobacco abuse, and he had taken nonsteroidal anti-inflammatory drugs (NSAIDs) for low back pain.

Upper endoscopy showed a deep ulcer with elevated borders and about 15 mm of diameter (Fig. 1) on the anterior wall of the duodenal bulb. The patient was treated with a proton-pump inhibitor.

Figure 1.

A deep ulcer with elevated borders and about 15 mm of diameter on the anterior wall of the duodenal bulb.

Endoscopic follow-up two months later showed two openings connecting the gastric antrum and the duodenal bulb (Fig. 2), separated by a tissue septum. The scope could enter the bulb through both openings. The findings were consistent with an acquired double pylorus from a duodenal bulb ulcer complication. Helicobacter pylori colonisation was not found on histology of gastric biopsies.

Figure 2.

Two openings connecting the lesser curvature of the gastric antrum and the duodenal bulb, consistent with a double pylorus.

Double pylorus is a rare condition characterised by the presence of a double communication between the gastric antrum and the duodenal bulb.¹ It may occur as a congenital abnormality or as an acquired complication of a penetrating ulcer.² It can be found incidentally or present with epigastric pain, dyspepsia or gastrointestinal bleeding.^1,2 The diagnosis is typically made based on endoscopic findings.¹ Treatment is mostly conservative, including proton-pump inhibitors, avoidance of NSAIDS and Helicobacter pylori erradication.^1–3

Disclosure statement

No conflicts of interest to declare.