A case report of double pylorus: a rare endoscopic finding

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

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 developed later. There are few case reports of this condition worldwide. Patients having 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. A typical, two-orifice pylorus is observed during diagnostic endoscopy. Medical management of such patients rests on proton pump inhibitors or histamine receptor blockers. Patients 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 for medical management and is currently under follow-up. 

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Footnotes. Mohamed Emara (professor of gastroenterology, hepatology, and infectious diseases) and Sara Salem (lecturer of internal medicine, gastroenterology, and hepatology unit) were the peer reviewers. E- Editor: Salem Youssef Mohamed, Osama Ahmed Khalil, Amany Mohammed. Copyright ©. This open-access article is distributed under the Creative Commons Attribution License (CC BY). It may be used, distributed, or reproduced in other forums, provided the original author(s) and the copyright owner(s) are credited. The original publication in this journal must be cited according to accepted academic practice. Disclaimer: The authors' claims in this article are solely their own and do not necessarily represent their affiliated organizations or those of the publisher, the editors, and the reviewers. Any product evaluated in this article or its manufacturer's claim is not guaranteed or endorsed by the publisher. Ethical approval: Written informed consent was obtained from the patient after the studies were well explained before data collection. The hospital's Research Ethics Review Committee approved the case report. Study protocol: In adherence to the principles outlined in the Helsinki Declaration, the study protocol was implemented with approval from the institutional review board. Before commencing the research, written consent was obtained from the patient to utilize their clinical information. Data and materials availability: The datasets used or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This study had no funding from any resource. This work was done according to the CARE guidelines. Authors' contributions Zelalem Mulu and Wudassie Melak collected and followed up on the patients, carrying out the requested investigations. Abdulsemed Nur and Mengistu Erke also followed up on the patients and analyzed the collected data. All authors authorized the manuscript. Acknowledgment: none.

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