A “Double Route” to Duodenum: The Unusual Case of Healing’s Bleeding Ulcer
Valeria D’Ovidio*, S Festa, D Lisi and ME Bazuro
UOSD Gastroenterology and Digestive Endoscopy, Italy
Submission: October 02, 2018;Published: October 15, 2018
*Corresponding author: Valeria D’Ovidio, UOSD Gastroenterology and Digestive Endoscopy, SEugenio Hospital, Rome, Italy, Email: vale_do@yahoo.it
How to cite this article: Valeria D’Ovidio, S Festa, D Lisi and ME Bazuro. A “Double Route” to Duodenum: The Unusual Case of Healing’s Bleeding Ulcer. 2018; 11(3): 555812. DOI:10.19080/ARGH.2018.11.555812.
Keywords: Hematemesis; Syncope; Epinephrine; Submucosal injection; Inflammatory Drugs; Ulcer; Urease; Duodenum;Pyloric channels
Abbrevations:NSAID: Non-Steroidal Anti-Inflammatory Drugs; PPIs: Proton Pump Inhibitors; EGDS: Esophagogastroduodenoscopy; DP: Double Pylorus
Case Report
A 79-year-old woman was admitted to the emergency room of our hospital for hematemesis and syncope(Hb was 9.9 g/dl). She referred chronic use of NSAID (Non-Steroidal Anti-Inflammatory Drugs) for arthralgia without any concomitant proton pump inhibitors (PPIs). An EGDS (Esophagogastroduodenoscopy) was promptly performed and a 25 mm, actively bleeding pre-pyloric antral ulcer was diagnosed (Forrest 1b).
A combined endoscopic treatment (epinephrine submucosal injection + clip placement) was successfully performed. A rapid urease test was negative. The patient was further treated with high dose of intravenous PPIs until she left hospital. Bleeding did not recur, and Hb level remained stable. At 1 month, a follow up EGDS was performed and a pre-pyloric fistula was highlighted. The duodenum could easily be entered via both of the pyloric channels.
Double pylorus (DP) is a rare condition (observed in 0.001% to 0.4% of upper gastrointestinal endoscopies) involving a double communication between the gastric antrum and the duodenal bulb [1]. Mostly, DP is a complication of a penetrating ulcer, a condition named acquired DP. Otherwise, DP occasionally occurs as a congenital abnormality, either isolated or in combination with other congenital abnormalities [2].
Conclusion
An acquired DP in our case was finally diagnosed.