Double Channel Pylorus as a Complication of Peptic Ulcer Disease

Abstract

Introduction: Double channel pylorus is a rare condition consisting of a gastro duodenal fistula extending from the gastric antrum to the duodenal bulb through an accessory canal. The double pylorus is a destructive but relatively benign complication of peptic ulcer disease. It could be congenital or acquired. Case Report: A 73-year-old female with history of cirrhosis secondary to non-alcoholic steatohepatitis with splenomegaly, thrombocytopenia, and peptic ulcer disease was admitted to the hospital for progressive shortness of breath and noted to have iron deficiency anemia. The patient underwent screening upper endoscopy as a part of screening for esophageal varices. She was noted to have some antral thickening extending to pylorus. Biopsies showed that the thickening was only focal fibrosis and reactive glandular atypia, but no tumor. Six months later, the patient was readmitted with worsening shortness of breath, and was found to have anemia and positive occult blood. Colonoscopy was done as a part of work-up, which was completely normal. Later, the patient underwent esophagogastroduodenoscopy (EGD). On EGD, the changes were consistent with mild gastritis and a duplicate opening lying adjacent to pyloric channel. The scope was passed through both the openings. First was the native pyloric channel. The duplicated pyloric channel seemed to open into the second part of the duodenum, and there was a large, clean bases ulcer, but no fistulas. There was shelve of normal tissue diving the 2 openings. Upper GI series was also done to confirm the diagnosis. Discussion: The 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 well as with other peptic diseases. Malignant tumors resulting in formation of double pylorus is extremely rare. Clinical symptoms are similar to those of peptic ulcer disease. They are identified on upper endoscopy and can also be seen on barium meal study. Convergence of double pyloric canals resulting into 1 large gastrointestinal passage can predispose to bile reflux. Other complications, like hemorrhage or intractable pain, may require surgical intervention. Double channel pylorus is a rare but important complication of peptic ulcer disease, and should be identified early to prevent complications.