Ioannis Pothoulakis, MD1, Mohammad Bilal, MD2 1University of Minnesota, Minneapolis, MN; 2Minneapolis VA Medical Center, Minneapolis, MN
Introduction: Gastroduodenal fistulous communications near the pylorus have been previously reported, and can be congenital or acquired. Cases of ‘double pylorus’ with a fistula extending from the gastric antrum to the duodenal bulb have been rarely reported before. To our knowledge, this is the first reported case of triple pylorus.
Case Description/Methods: A 68-year-old man with a past history of hypertension, diabetes mellitus underwent esophagogastroduodenoscopy (EGD) for evaluation of melena. EGD revealed an ulcer in the gastric antrum, with biopsies showing chronic inactive gastritis, and negative Helicobacter pylori testing. Patient was discharged on proton pump inhibitor therapy and underwent repeat EGD after 8 weeks, which showed antral erythema with a possible fistula in the antrum. The patient was then referred to advanced endoscopy for further exploration and management of fistula under fluoroscopy. Upon repeat endoscopy, two openings were found measuring 2 mm and 6 mm in the antrum adjacent to the pylorus. These 2 fistulous openings were explored with a pediatric upper endoscope and showed communication with the duodenal bulb, consistent with triple pylorus.
Discussion: This case highlights an unusual finding of two fistulous communications between the gastric antrum and duodenal bulb, consistent with triple pylorus. While cases of double pylorus have been previously identified, to our knowledge, this is the first reported case of triple pylorus. It is important for gastroenterologists to recognize this as an acquired complication secondary to peptic ulcer disease (PUD), and should not necessitate further investigation with unnecessary procedures such as fluoroscopy or imaging studies to rule out malignancy.
Figure: Upper gastrointestinal endoscopy showing three opening in the gastric antrum, an intact pylorus and two fistulas communicating with the duodenal bulb.
Disclosures:
Ioannis Pothoulakis indicated no relevant financial relationships.
Mohammad Bilal: Boston Scientific – Consultant.
Ioannis Pothoulakis, MD1, Mohammad Bilal, MD2. P0583 - Triple Pylorus: It Can Happen!, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
