Document Type: Case Reports
Authors
1 Gastroenterology, Internal Medicine, Felege Hiwot Comprehensive Specialized Hospital, Bahirdar, Ethiopia
2 Internal medicine, Medical, Bahirdar University, Bahirdar, Ethiopia
3 Gastroenterology, Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
10.21608/ajgh.2025.331053.1067
Abstract
Introduction
Double pylorus, or duplication of the pylorus, is a rare condition characterized by a gastrointestinal fistula between the gastric antrum and the duodenal bulb. It may be present at birth or develop later. Few case reports of this condition exist worldwide. Patients who have acquired double pylorus have symptoms related to the underlying cause, such as peptic ulcer disease or other conditions like gastric cancer. In congenital cases, most are asymptomatic.
Case presentation
We report a case of a 41-year-old female with a history of epigastric burning-type pain for the past 1 week, which was associated with a single episode of hematemesis. She received treatment with intravenous omeprazole for the same period before being referred to our hospital. The physical findings were unremarkable. She was evaluated with endoscopy, during which a double pylorus was incidentally found. She was later treated with 40mg of pantoprazole orally once daily, with subsequent improvement in symptoms.
Conclusion
Double pylorus is a rare and unexpected endoscopic finding. During diagnostic endoscopy, a typical, two-orifice pylorus is observed. Proton pump inhibitors or histamine receptor blockers are used to manage such patients. Patients who are refractory to medical management and those with symptoms of gastric outlet obstruction benefit from interventional endoscopic procedures and surgical management for optimal outcomes. Our patient responded to medical management and is currently undergoing follow-up.
Double pylorus, or duplication of the pylorus, is a rare condition characterized by a gastrointestinal fistula between the gastric antrum and the duodenal bulb. It may be present at birth or develop later. Few case reports of this condition exist worldwide. Patients who have acquired double pylorus have symptoms related to the underlying cause, such as peptic ulcer disease or other conditions like gastric cancer. In congenital cases, most are asymptomatic.
Case presentation
We report a case of a 41-year-old female with a history of epigastric burning-type pain for the past 1 week, which was associated with a single episode of hematemesis. She received treatment with intravenous omeprazole for the same period before being referred to our hospital. The physical findings were unremarkable. She was evaluated with endoscopy, during which a double pylorus was incidentally found. She was later treated with 40mg of pantoprazole orally once daily, with subsequent improvement in symptoms.
Conclusion
Double pylorus is a rare and unexpected endoscopic finding. During diagnostic endoscopy, a typical, two-orifice pylorus is observed. Proton pump inhibitors or histamine receptor blockers are used to manage such patients. Patients who are refractory to medical management and those with symptoms of gastric outlet obstruction benefit from interventional endoscopic procedures and surgical management for optimal outcomes. Our patient responded to medical management and is currently undergoing follow-up.
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