Píloro doble. Presentación de un caso y revisión de la literatura / Double pylorus. Case report and literature review

RESUMEN El doble píloro es una comunicación anormal entre el antro gástrico y el bulbo duodenal y representa un raro hallazgo endoscópico. Se presentó un paciente de 80 años de edad, con antecedentes de hipertensión arterial, fumador inveterado, tomador de aspirina, que presentó melena aproximadamente 15 días antes del ingreso. La videoendoscopia reveló la existencia de dos orificios similares en el antro, que se comunicaban con el bulbo duodenal de manera independiente que fueron catalogados como píloros. La comunicación se constató con el paso del endoscopio a su través. Se impuso tratamiento médico con inhibidores de la bomba de protones y la evolución fue favorable. Es el cuarto caso reportado en la literatura en nuestro país y el primero en la provincia de Matanzas.

ABSTRACT Double pylorus is an abnormal communication between the gastric antrum and the duodenal bulb and represents a rare endoscopic finding. It is presented the case of a patient aged 80 years, with a background of arterial hypertension, inveterate smoker, taking aspirin, who presented melena about 15 days before the admission. The video-endoscopy revealed the existence of two similar orifices in the antrum that were independently communicating with the duodenal bulb and they went catalogued like pylori. The communication was proved by passing the endoscope through it. He was treated with IBP (the Spanish acronym for proton bomb inhibitors) and the evolution was favorable. It is the fourth case reported in the literature in Cuba and the first one in Matanzas.

Píloro doble: de lo cotidiano a lo extraordinario: reporte de caso y revisión de la literatura / Double pylorus: from the everything to the extraordinary: case report and literature review

Antecedentes: El píloro doble constituye un hallazgo endoscópico extremadamente raro, siendo más frecuente en pacientes que padecen enfermedad ulcerosa péptica. Corresponde a una comunicación anormal entre el antro gástrico y el bulbo duodenal, que puede llegar a requerir tratamiento quirúrgico. Caso clínico: Mujer de 86 años de edad con antecedentes de diabetes mellitus tipo 2, hipertensión arterial, así como ingesta crónica de AINE, portadora de enfermedad ácido-péptica de larga evolución con poca respuesta al manejo médico con bloqueadores H2, la cual presenta sangrado de tubo digestivo durante 5 días caracterizado por hematemesis y melena, así como pirosis, náuseas, sin pérdida ponderal; por este motivo se realiza endoscopia digestiva alta la cual reporta como hallazgos: gastritis erosiva crónica activa secundaria a AINE y asociada a Helicobacter pylori, así como píloro doble adquirido secundario a enfermedad ácido-péptica, sin evidencia de tumores u otras lesiones asociadas. Se inicia esquema de erradicación para H. pylori con amoxicilina y claritromicina durante 14 días, asociados a inhibidor de bomba de protones durante 6-8 semanas con buena respuesta al manejo médico. Discusión: El píloro doble adquirido es una rara complicación de úlcera péptica que puede ser asociada a otras enfermedades, AINE y a la colonización por H. pylori, por lo tanto el adecuado tratamiento consistirá en la corrección de esos factores.

Background: The double pylorus is an extremely rare endoscopic finding, being more frequent in patients suffering from peptic ulcer disease. It corresponds to an abnormal communication between the gastric antrum and the duodenal bulb, which may require surgical treatment. Clinical case: A 86-year-old woman with a history of type 2 diabetes mellitus, hypertension and chronic NSAID intake, a carrier of long-term peptic acid disease with poor response to medical management with H2 blockers. This presents digestive tube bleeding for 5 days characterized by hematemesis and melena, as well as heartburn, nausea, without weight loss, reason why high digestive endoscopy is performed, which reports as findings: active chronic erosive gastritis secondary to NSAIDs and associated with Helicobacter pylori, as well as acquired double pylorus secondary to peptic acid disease, without evidence of tumors or other associated lesions. Eradication scheme begins for H. pylori with amoxicillin and clarithromycin for 14 days, associated with a proton pump inhibitor for 6-8 weeks with good response to medical management. Discussion: The acquired double pylorus is a rare complication of peptic ulcer disease that can be associated with other diseases, NSAIDs and colonization by H. pylori, therefore the appropriate treatment will consist in the correction of these factors.

Doble piloro adquirido: una complicación poco usual de enfermedad úlceropeptica. A propósito de un caso / DOUBLE ACQUIRED PYLORUS: AN UNUSUAL COMPLICATION OF PEPTIC ULCER DISEASE. ABOUT A CASE

El Doble Píloro (DP) es un hallazgo endoscópico inusual en el que el antro gástrico se conecta al bulbo duodenal por dos orificios separados por un septo, tabique o puente. Su etiología puede ser congénita o adquirida siendo esta última la forma más común como complicación de una enfermedad ulcero péptica (EUP). La mayoría de las fistulas están localiza­das en la curvatura menor de antro gástrico. En los casos de DP adquirido se han descrito tres teorías en cuanto a su forma­ción. Puede presentarse con dolor en epigástrico, dispepsia o hemorragia digestiva aunque en ocasiones es un hallazgo ca­sual endoscópico o radiológico. En este caso presentamos a un paciente quien acude con clínica de Hemorragia Digestiva Superior a quien se le realiza gastroscopia donde se eviden­cia este hallazgo poco usual el cual fue confirmado mediante estudio radiológico. En general el pronóstico es favorable.

The Double Pylorus (DP) is an unusual finding in the gastros­copy where the gastric antrum and the duodenal bulb is con­nected to by two holes separated by a septum or bridge. Its etiology may be congenital or acquired the latter being the most common form as a complication of peptic ulcer disease (EUP). Most fistulas are located on the lesser curvature of the gastric antrum. There have been described three theories in the formation of acquired DP. It may present with epigastric pain, dyspepsia or gastrointestinal bleeding but sometimes it is an endoscopic or radiological incidental finding. We present a patient who presents with upper gastrointestinal bleedings­ymptoms in whom a gastroscopy where performed with this unusual finding which was confirmed by radiological study. In general the prognosis is favorable.

A Case of Gastroduodenal Fistula Caused by Gastric Ulcer

Gastroduodenal fistula or double pylorus is a very rare condition. It is a fistulous communication between gastric antrum and duodenal bulb. It can be either congenital or acquired. In most cases it is thought to be a complication of gastric ulcer. We recently experienced a case of gastroduodenal fistula in 70 year-old man presenting as epigastric pain. He was diagnosed with non ST elevation myocardial infarction previously, and was taking aspirin. Gastroduodenal communication was revealed by endoscopy. We report a case of gastroduodenal fistula that developed in man who was taking aspirin, with review of the literature.

A Case of Double Pylorus Presenting with Ulcer Bleeding / 이화의대지

Double pylorus is one of the rare anomalies of gastrointestinal tract, which have an accessory canal connecting the distal stomach to the duodenal bulb. The majority of the cases is thought to be acquired lesions from ulcer disease except some congenital cases. We report a case of a 77 year-old male who was visited the hospital because of the melena and diagnosed double pylorus. The relevant literatures on subject were reviewed.

A Case of Double Pylorus Developed on the Gastric Body / 대한소화기내시경학회지

Double pylorus is a rare disease. It is described by a double communication between the gastric antrum and the duodenal bulb. The cause of double pylorus is either a congenital abnormality or an acquired condition. It is believed to be mostly a complication of peptic ulcer disease. Most reports revealed conditions only for the gastric antrum. However, case reports describing the involvement of the gastric body are extremely rare. Herein, we report a case of a double pylorus that developed on the gastric body and we present a review of the literature.

A Case of Double Pylorus Caused by Peptic Ulcer in a Diabetic Patient / 대한소화기내시경학회지

A double pylorus, a fistulous communication between the gastric antrum and duodenal bulb, is a very rare anomaly. It appears as an acquired lesion in the majority of cases and mainly occurs in males with chronic obstructive pulmonary disease, chronic renal failure, chronic rheumatism, systemic lupus erythematosus, or diabetes. However, there are no previous reports of a double pylorus combined with diabetes mellitus in Korea. Recently we experienced a case of double pylorus caused by a peptic ulcer in 74-year-old man who had diabetes mellitus with complications. We report this case with a review of the literature.

A Case of Double Pylorus Accompanied by Duodenal Ulcer / 대한소화기내시경학회지

Double pylorus is a rare abnormality of the gastrointestinal tract and it presents as two openings between the gastric antrum and the duodenal bulb. The acquired type is more common than the congenital one and this acquired type arises secondary to peptic ulcer disease. A 68-year-old man visited the gastrointestinal clinic and he presented with chronic epigastric pain and dyspepsia. Upper endoscopy showed double pylorus with an accessory channel on the lesser curvature side of the prepyloric antrum and also an active duodenal ulcer. Upon review of the patient's past history and examination, the findings of the upper endoscopy that was done 7 years previously were within the normal limits. The patient was diagnosed as having a double pylorus secondary to duodenal ulcer and he treated conservatively with anti-ulcer therapy. We report here on a case of double pylorus along with the brief review of the literature.

A Case of Double Pylorus Accompanied by Duodenal Ulcer / 대한소화기내시경학회지

Double pylorus is a rare abnormality of the gastrointestinal tract and it presents as two openings between the gastric antrum and the duodenal bulb. The acquired type is more common than the congenital one and this acquired type arises secondary to peptic ulcer disease. A 68-year-old man visited the gastrointestinal clinic and he presented with chronic epigastric pain and dyspepsia. Upper endoscopy showed double pylorus with an accessory channel on the lesser curvature side of the prepyloric antrum and also an active duodenal ulcer. Upon review of the patient's past history and examination, the findings of the upper endoscopy that was done 7 years previously were within the normal limits. The patient was diagnosed as having a double pylorus secondary to duodenal ulcer and he treated conservatively with anti-ulcer therapy. We report here on a case of double pylorus along with the brief review of the literature.

A Case of Double Pylorus Associated with Chronic Bronchitis and Gastric Ulcer / 대한소화기내시경학회지

The double pylorus is a fistulous communication between gastric antrum and duodenal bulb. It appears to be an acquired lesion in the majority of cases. Upon routine endoscopic procedures, it is frequently seem to occur in males who are either alcoholics, diabetics, those with chronic renal failure, chronic lung disease. If it is no developing complications such as septal rupture, double pylorus is well response to medical treatment. A 51-year-old man who had been taking medication over a long period for the chronic bronchitis was admitted to this hospital because of epigastric soreness and indigestion for 1 month. Endosopic findings showed two large openings of the pyloric channel and gastric ulcer in the channel. We thought that this case was an acquired lesion reasult of repeated gastric ulcer. We report a case of double pylrous with the brief review of literatures.

A Case of Double Pylorus Associated with Ectopic Pancreas Presenting with Gastric Ulcer Bleeding / 대한소화기내시경학회지

Duplication of the pylorus is one of the rare anormalies of the intestinal tract. Most of the reported cases are secondary double pylorus caused by peptic ulcer. However, double pylorus may be a congenital anomaly sometimes combined with ectopic pancreas. Recently, we experienced a case of double pylorus combined with ectopic pancreas in a 76-year-old man. The patient presented with gastric ulcer bleeding. An esophagogastroduodenoscopy confirmed the presence of double pylorus, but subsequent endoscopic hemoclipping failed to control bleeding from an ulcer on the lesser curvature of the prepyloric antrum. The microscopic examination of the surgically resected specimen showed an ectopic pancreatic tissue in the gastric wall near the ulcer lesion. We report this case with a collected review of the Korean literature.

Three Cases of Double Pylorus Due to Gastroduodenal Fistula Complicating Peptic Ulceration: Disappearance of gastroduodenal fistula in 1 case after eradication of a Helicobacter pylori infection / 대한소화기내시경학회지

Double pylorus is either a congenital abnormality or an acquired complication of peptic ulcer disease. An accessory channel normally connects the lesser or greater curvatore of the prepyloric antrum with the duodenal bulb. Three cases of double pylorus, an unusual complication of peptic ulcer disease is herein reported. A peptic ulcer lay in the accessory channel in all cases. In one of the cases, the fistula closed spontaneously after Helicobacter pylori eradication. The remaining 2 patients became asympto-matic despite the persistence of the accessory channel.

A Case of Double Pylorus / 대한소화기내시경학회지

The double pylorus is a rare condition consisting of a double communication between gastric antrum and duodenal bulb. Some investigators postulate that the doubling of the pyloric channel is a congenital phenornenon, but others believe that it is an acquired lesion. A 72 year-old-man was admitted to this hospital because of epigastric pain for 1 month. Upper G-I series revealed thickened rnucosal folds of pylorus and duodenal bulb and dilated, deformed duodenal bulb filled with barium materials. Endoscopic findings also showed two ovoid large openings of the pyloric channel divided by smooth thickened septum and multiple gastroduodenal ulcers. We thought that this case was an acquired lesion. The relevant literatures on the subject were reviewed.

Double Pylorus, A Case Report / 대한소화기내시경학회지

Double pylorus is a rare condition consisting of a double communication between gastric antrum and duodenal bulb; in most cases it is a complication of penetrating ulcer, and sometimes it is a congenital abnormality. The prevalence of this rare anomaly ranges from 0.02% to 0.13%; the male: female ratio is about 2: 1. A case of double pylorus, in 41 year-old male, was diagnosed by gastrofiberscopy and UGIS. Two ovoid and crescent pits of the pyloric canal divided by smooth thickened septum were observed endoscopically. The upper GI series showed gastroduodenal fistula connecting the leeser curve of distal antrum with the duodenal bulb. The relevant literatures on the subject were reviewed.

Double Pylorus: A Case report / 대한소화기내시경학회지

A Case of double pylorus, in 56 year old man, was diagnosed by fiberoptic gastroscopy and upper gastrointestinal series. Two ovoid large openings of pyloric canal divided by smooth thickened septum were observed endoscopically And the relevant literatures on tihe subject were reviewed.

Two case reports and review of the literature / 대한소화기내시경학회지

The double pylorus-is a fistulous communication between the gastric antrum and duodenal bulb, usually extending from the lesser curvature of the stomach to the superior aspect of the duodenal bulb, and seperated by septum or bridge of normal mucosa. Although its incidence is rare, reports concerning double pylorus are increasing with the recent development of upper gastrointestinal endoscopy and more awareness of this abnormality. We recently experienced two cases of double pylorus; an aquired one in 72-year old male who had an another opening with healing ulcer at the superior aspect of the original pyloric channel, central erosion with clubbing and fusion of mucosal folds at the greater curvature of the lower body and a 3 x 4 cm sized ulcer at the lesser curvature of the lower body, and the other congenital one in 53-year old male who had an another opening at the superior aspect of the original pyloric channel with histologically intact muscularis mucosa in the pyloric septum with no evidence of chronic peptic ulcer scarring. We report here two cases of double pylorus, one-acquired, and the other-congenital, with a review of the literature.