Congenital double pylorus (CDP) is an extremely rare congenital disease in which both the prosopyle and apopyle are intercommunicated with the gastric antrum and duodenal bulb. The pylorus of CDP is composed of normal mucous epithelium, the lamina propria, and the muscularis mucosae. However, a few CDP operations have proved the lack of the muscularis mucosae but the existence of heterotopic pancreas tissues in the pylorus of CDP. This article reports a case of CDP complicated with duodenal ulcer in a 67-year-old man. He presented with repeated epigastric pain for 8 years and melena for 6 years, with recurrence for 3 d. He was positive for Helicobacter pylori (H. pylori) antibody. Gastroendoscopy performed 8 years ago revealed double pylorus, bile reflux gastritis, and duodenal bulbar inflammation. Gastroendoscopy performed 6 years ago revealed double pylorus with a duodenal bulbar ulcer lesion, and pathological examination suggested chronic inflammation in the duodenal bulbar mucosa, accompanied with low grade gland dysplasia. A second gastroendoscopy performed 6 years ago also revealed double pylorus with a duodenal bulbar ulcer (A2 stage). Gastroendoscopy at our hospital revealed double pylorus and pyloric canal inflammation, and pathological examination suggested pyloric canal mucosal inflammation accompanied with erosion and mild intestinal metaplasia. He was then given proton pump inhibitor therapy combined with anti-H. pylori therapy, and his symptoms were obviously improved. This case suggests that gastroendoscopy is the most direct and accurate method for the diagnosis of CDP.

• Congenital double pylorus
• Duodenal bulb ulcer
• Double pylorus
• Acquired double pylorus
• Gastroendoscopy

Double pylorus (DP), or duplication of the pylorus, is an uncommon condition that can be either congenital or acquired. Acquired DP (ADP) occurs when a peptic ulcer erodes and creates a fistula between the duodenal bulb and the distal stomach. The clinical features and endoscopic characteristics of four patients with ADP were reviewed and compared with previously reported cases. An accessory channel connects the lesser curvature of the prepyloric antrum with the duodenal bulb, and in all cases, a peptic ulcer was located in or immediately adjacent to the accessory channel. In one of the patients, the bridge between the double-channel pylorus disappeared, resulting in a single large opening and duodenal kissing ulcer after two years and three months. Finally, nonsteroidal anti-inflammatory drugs, Helicobacter pylori and other risk factors associated with ADP are assessed.

• Acquired double pylorus
• Peptic ulcer
• Gastrointestinal hemorrhage
• Nonsteroidal anti-inflammatory drugs
• Helicobacter pylori

• Adult
• Anti-Bacterial Agents/therapeutic use
• Anti-Ulcer Agents/therapeutic use
• Duodenal Diseases/diagnostic imaging
• Duodenal Diseases/etiology
• Duodenal Diseases/therapy
• Endoscopy, Digestive System
• Female
• Gastric Fistula/diagnostic imaging
• Gastric Fistula/etiology
• Gastric Fistula/therapy
• Humans
• Intestinal Fistula/diagnostic imaging
• Intestinal Fistula/etiology
• Intestinal Fistula/therapy
• Male
• Middle Aged
• Peptic Ulcer Hemorrhage/etiology
• Predictive Value of Tests
• Proton Pump Inhibitors/therapeutic use
• Pylorus/diagnostic imaging
• Risk Factors
• Stomach Ulcer/complications
• Stomach Ulcer/diagnostic imaging
• Stomach Ulcer/therapy
• Treatment Outcome

Acquired double pylorus (DP) is an uncommon condition consisting of two communicating channels between the gastric antrum and the first part of duodedum. Little is known about the origin of DP. As there is no specific gastrointestinal symptom due to DP, most often it is diagnosed by gastroscopy while performing for other indicationsFew data are also known about the clinical course of DP. In the patients with peptic ulcer symptoms, the pyloroplasty-like drainage effect, improving gastric emptying after the estabilishment of the fistula, could relieve these symptoms. This represents an unresolved issues about the necessity of repeating endoscopy to document in the patients with DP its final outcome, as the risk of ulcer recurrence. We describe a case of a 76-years-old woman admitted to our department for hyposideremic anemia associated to a recent history of melena.

• Double pylorus
• Gastric ulcer

• salicylic acid
• peptic ulcer
• duodenal ulcer
• gastric ulcer
• peptic ulcer disease

• Aged, 80 and over
• Duodenal Diseases/diagnosis
• Duodenal Ulcer/complications
• Female
• Gastric Fistula/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastroscopy
• Humans
• Intestinal Fistula/diagnosis
• Pylorus
• Stomach Ulcer/complications