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Review
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Korean J Med. 2006;71(1):241-241.
- Double pylorus with active gastric ulcer
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- Double pylorus with active gastric ulcer
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1Department of Internal Medicine, Hanyang University College of Medicine, Seoul; 2Department of Life Science, Postech Biotech Center, Pohang University of Science and Technology, Pohang, Korea
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- Abstract
- A double pylorus is a relatively rare condition consisting of a double communication between the stomach and the duodenal bulb.
It may be either congenital or acquired, but in most cases it arises as an acquired complication of peptic ulcer. The patient was
a 86-year-old woman who was investigated because of melena for several days. She had a long history of treatment with
nonsteroidal anti-inflammatory drugs due to osteoarthritis. A laboratory evaluation revealed reduced hemoglobin concentration
(6.7 g/dL) and hematocrit (20.6%). Blood urea nitrogen was elevated (76.9 mg/dL). Total serum protein level (5.4 g/dL) and
serum albumin level (2.5 g/dL) were relatively lower. An endoscopic examination showed large fistular opening with lack of
peristalsis on the lesser curve of the prepyloric antrum (Fig. 1). The fistular opening and the pylorus were separated by a
septum. The scope was progressed toward the pylorus and then active ulcer with clean bed was revealed at the oral side of
the fistular opening (Fig 2). Forceps biopsies taken from the ulcer site, septum and the antrum revealed histologically no
colonization of Helicobacter pylori, with no evidence of malignancy. She was treated with oral proton pump inhibitor and then
discharged after 10 days with improved condition. After 2 months, she had no gastrointestinal symptom and endoscopic
examination revealed double pylorus with persistent fistular opening on the lesser curve of the prepyloric antrum and the well
healed ulcer scar.
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