A 73-year-old gentleman presented with abdominal pain and melaena. Endoscopy showed evidence of a double pylorus, with erosive duodenitis in the duodenal bulb. A CLO test for helicobacter pylori was negative. He was treated with regular proton pump inhibitor.
Double pylorus is usually an acquired condition associated with peptic ulcer disease, but rarely it can be congenital. It is found in less than 0.4% of endoscopies. The normal pathological mechanism is of a peptic ulcer at the gastric antrum or duodenal bulb causing adhesion between the adjacent walls of stomach and duodenum, and leading to a fistulous tract that becomes epithelized. Occasionally double pylorus can result from ulceration by a gastric or duodenal malignancy, and so any suspicious irregularities should be biopsied. Treatment is with acid suppression and eradication of helicobacter pylori if present.
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