Double Pylorus

Double pylorus is a rare condition consisting of a gastroduodenal fistula extending from the gastric antrum to the duodenal bulb through an accessory canal. It is most commonly a complication of peptic ulcer disease; however, it can also be congenital. The presumed pathophysiologic mechanism when associated with PUD is that an ulcer at either the gastric antrum or duodenal bulb causes adhesion between the adjacent walls of stomach and duodenum with posterior penetration along the muscular layer, leading to a fistulous tract that becomes epithelized. The fistula usually presents on the lesser curvature of the gastric antrum and the superior wall of the duodenal bulb.

The reported prevalence of double pylorus varies from 0.06 to 0.4%; however, its real incidence remains unknown. It occurs more often in men (2:1), as with other peptic diseases. In most patients, double pylorus responds well to medical treatment such as H2-antagonists, antacids, or proton pump inhibitors, regardless of whether or not the fistula remains patent.

Radiographic Findings:

• Contrast is visualized entering the duodenum through the pyloric canal and an accessory tract, typically along the lesser curvature.

• Signs of active peptic ulcer disease may be present.