Double pylorus; a Rare Disorder Presenting with Gastrointestinal Bleeding
Onur Cengiz, *2Barış Sevinç
Department of Gastroenterology, Medical Park Uşak Hospital, Uşak, Turkey
2Department of General Surgery, Uşak University Faculty of Medicine, Uşak, Turkey
Corresponding author: Barış Sevinç, Department of General Surgery, Uşak University Faculty of Medicine, Uşak, Turkey, Tel:
+905054880511, E-mail: firstname.lastname@example.org.
Citation: Barış Sevinç, et al. (2017) Double pylorus; a Rare Disorder Presenting with Gastrointestinal Bleeding. Int J Sur &Trans Res.
Copyright: © Barış Sevinç et al. This is an open-access article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are
Recieved Date: January 23, 2017; Accepted Date:
January 30, 2017; Published Date:
January 31, 2017.
Introduction: Double pylorus is a condition defined as two pyloric openings between gastric antrum and duodenal bulb. The condition
can be congenital or acquired.
Case: In this report we present a case with double pylorus deformity, admitted to hospital with gastrointestinal bleeding.
Conclusion: Double pylorus is a very rare condition. Ulcer causing the condition can be presented with gastrointestinal bleeding.
Treatment of the condition is mostly medical.
Double pylorus, gastrointestinal bleeding, gastric ulcer
Double pylorus is a very rare condition mostly seen as a
complication peptic ulcer disease (1, 2). The condition is defined
as two pyloric openings between gastric antrum and duodenal
bulb. Most commonly accepted theory is; due to the repeated
erosion of an ulcer, formation of a fistula between the antrum and
duodenal bulb. There is passage by the both openings and they are
separated by a bridge of tissue. This bridge mostly consists of the
muscular ring of the true pylorus. Contractions can be seen at the
Although, the real incidence of the condition is unknown it is
reported to be between 0.002% - 0.04% (3, 4). The condition can
also be congenital. However, congenital double pylorus is very
rare (5). Most of the cases with acquired double pylorus have a
history of peptic ulcer disease. However, congenital double pylorus
believed to be a result of abnormal duplication of the pylorus.
In this report we present a case with upper gastrointestinal bleeding
with double pylorus.
Eighty-one years old male patient admitted to emergency room
department with complaints of epigastric pain and melena. Patient
had a haemoglobin level of 8.4 gr/dl at the admittance. He has
history of cerebrovascular disease and chronic arthralgia. He also
has history of chronic acetylsalicylic acid and nonsteroidal antiinflammatory
drugs (NSAIDs) use. At the upper gastrointestinal
endoscopy, two openings between the gastric antrum and duodenal
bulb were seen (Images 1). There was fibrin clotted ulceration at
the larger opening. The smaller opening has contractions and it
was assumed as the true pylorus (Image 2). Gastroscope could
pass through the both openings with ease. Biopsies were obtained
around the ulcer. Biopsy results revealed chronic ulceration with
no findings of malignancy. Helicobacter pylori was not detected at
the biopsy material. The patient underwent acid inhibition by high
dose proton pump inhibitors.
Double pylorus is a very rare condition. Although the real incidence
is unknown, in several studies it is reported to be between 0.002%
- 0.4% (3, 4). Commonly, double pylorus is an incidental finding
during upper gastrointestinal system endoscopy (6). However, as
in the current case, the ulcer leading to formation of the disorder
may cause symptoms like pain or even bleeding (7). Most of the
lesions are located between the gastric antrum at the side of lesser
curve and superior part of duodenal bulb.
It believed that formation of a fistulae because of the gastric ulcer
causes the anomaly, however duodenal ulcers may also cause
double pylorus formation (8). As potential ulcerogenic drugs
NSAIDs play important role in the formation of the anomaly.
Similarly, our case had chronic NSAIDs use.
Treatment of the disorder mainly depend on acid suppression via
proton pump inhibitors. In the current case patient was administered
high dose proton pump inhibitors. Helicobacter pylori may play
important role in ulcer formation and recurrent ulcers. However,
in the current case we could not demonstrate helicobacter pylori at
the biopsy specimens.
Surgical intervention is not the primary treatment choice for the
double pylorus. However, for cases with recurrent bleeding or
recurrent ulcers under acid reduction treatment surgical treatment
can be the treatment choice.
In conclusion double pylorus is mostly seen as a complication
of gastric ulcers. Similarly, with the causing disorder, primary
treatment choice is acid suppression with antiulcer drugs and
stopping usage of ulcerogenic drugs.
- Kwan WH, Yeung WH, Chan TM, Cheng CS. Double pylorus
with occult gastrointestinal bleeding. J HK Coll Radiol 2001; 4:
- Safatle-Ribeiro AV, Ribeiro Junior U, Habr-Gama A, GamaRodrigues
JJ. Double pylorus: case report and review of the
literature. Rev Hosp Clin Fac Med Sao Paulo 1999; 54: 131-4.
- Qing-Yu Chen, Yan Chen, Liang, Jing Wang, Qin Du, Jian-Ting
Cai, Jia-Min Chen. Acquired double pylorus: A case report. Asian
Pacific Journal of Tropical Medicine. 2012; 503-504
- Akazawa Y, Mizuta Y, Osabe M, Nakamura T, Morikawa S,
Isomoto H, et al. A case of double pylorus caused by recurrent
gastric ulcers: a long-term endoscopic observation. Dig Dis Sci
2005; 50: 2125-8.
- Ruvashni Naidoo, Bhugwan Singh. Congenital Double Pylorus.
Case Reports in Gastrointestinal Medicine 2012; Article ID
537697, 2 pages
- Mohammad Reza Fattahi, Katayoon Homayoon, Laleh
Hamidpour. Double Pylorus in a Cirrhotic Patient: A Case Report
and Review of the Literature.
- Middle East Journal of Digestive Diseases. 2012; 4: 130-132
- P. Peixoto, A. Sadio, E. Cancela, A. Castanheira, P. Ministro,
A. Silva and A. Caldas. Acute upper bleeding due to an unusual
complication of peptic ulcer disease – double pylorus. Rev Esp
Enferm Dig. 2010; 102: 450-458
- Hu TH, Tsai TL, Hsu CC, Lu SN, Hsiao M, Changchien CS.
Clinical characteristics of double pylorus. Gastrointest Endosc
2001; 54: 464-70.