Double Pylorus in Upper Gastrointestinal Bleeding

Double pylorus, also known as acquired double pylorus, is a rare condition defined as a gastrointestinal fistula connecting stomach antrum and duodenal bulb. The prevalence of double pylorus ranges from 0.001 to 0.4% by esophagogastroduodenoscopy (EGD). Although the etiology is unknown, the formation of double pylorus is related to Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs (NSAID). The development of the occurrence of double pylorus is still unknown, but many systemic diseases play a role. We present the case of a 59-year-old man who was admitted to Dr. Soetomo General Hospital with hematemesis and melena. The patient had a history of diabetes mellitus since 3 years and consumption of medicinal herbs for myalgia, which was suspected of NSAIDs for the past 5 months. The patient had anemia with hemoglobin at 8.3 g/dL, enterogenous azotemia with blood urea nitrogen 28 mg/dL and serum creatinine 1.14 mg/dL. At EGD, double pylorus was found and accompanied by gastric ulcer, a giant white base ulcer, part of it covered by clotting without any sign of active bleeding. Biopsy revealed chronic inactive gastritis, and no H. pylori was found. Treatment mainly depends on gastrointestinal acid suppression through a proton pump inhibitor (PPI). The patient was given a high-dose PPI and a mucosal protective agent. He was treated for 1 week and had improved complaints.

Double pylorus: unusual endoscopic finding in peptic disease.

Resumen Hombre de 59 años que consulta por melenas y vómitos en posos de café. En tratamiento con heparina desde una semana antes. Se realiza endoscopia digestiva alta objetivando doble píloro y úlcera Forrest IIa de 2 cm en cara anterosuperior de bulbo. El doble píloro o fístula gastroduodenal es un hallazgo endoscópico raro. Se debe a la formación de una fístula entre el estómago y el duodeno. Su incidencia es menor del 0.4%. Como en el caso presentado, habitualmente se forma en el lado de la curvatura menor. Puede ser congénito o adquirido. El doble píloro congénito es extremadamente raro. El doble píloro adquirido se relaciona con la enfermedad péptica gástrica. En la mayoría de los casos la fístula no cierra aunque cicatrice la úlcera.