Double pylorus: a case report and review of the literature

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. There are a few case reports of this condition worldwide with limited data in countries with low resource settings including Ghana. 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.

We present two cases of a 72-year-old Akan woman from Berekum in the Bono region and 15-year-old girl from Kumasi in the Ashanti region both Ghanaians who presented symptoms suggestive of peptic ulcer disease diagnosed incidentally at endoscopy, who had relief following medical treatment. The 72-year-old woman had symptoms suggestive of peptic ulcer disease over the last 5 months. She had a history of high blood pressure and took medications for both diseases. She denied the intake of alcohol and nonsteroidal anti-inflammatory drugs (NSAIDs). The 15-year-old girl had been complaining of abdominal pain for the past 6 years and had been seen at several facilities without a firm diagnosis. A biopsy of the ulcer for both patients was taken for histopathology, which later confirmed a gastric ulcer with no malignant features. The Helicobacter pylori quick test proved positive using a qualitative rapid urease test to detect the organism in gastric mucosa biopsy taken during endoscopy and the patients received triple therapy that consists of Metronidazole 400 mg three times daily, Amoxicillin 1 g twice daily, and Omeprazole 20 mg twice daily all for 10 days. This will provide more details in managing double pylorus in the aged and young populations.

Double pylorus is a rare condition caused primarily by peptic ulcer disease. It may be congenital or acquired. Acquired cases are more prevalent and typically more symptomatic. Endoscopy is a reliable diagnostic modality.