The patient was a 67-year-old man, who arrived at the emergency department and referred with chronic epigastric pain and dyspepsia over the last 6 months and felt weakness. He suffered from diabetes mellitus type 2 and high blood pressure and took medications for both diseases. Currently, he reported that he periodically took nonsteroidal anti-inflammatory drugs (NSAIDs) for arthralgia during the last year, without taking inhibitor of gastric acid and he denied having black or bloody stools. Physical examination revealed only mild upper abdominal tenderness and the blood tests showed microcytic anemia with hemoglobin 10.1 g/L and iron deficiency with ferritin 13 ng/mL and iron 27 µg/dL. He underwent an esophagogastroduodenoscopy and colonoscopy as an outpatient due to gastrointestinal symptoms and microcytic anemia. The colonoscopy was normal, while the esophagogastroduodenoscopy revealed a normal esophagus, gastritis with erosions, a double pylorus and a normal duodenum. Specifically, an accessory channel connected the lesser curvature of the prepyloric antrum to the duodenal bulb and the endoscope was able to easily pass via both of the pyloric channels ().\nFurthermore, the Helicobacter pylori quick test proved positive, while histological examinations of gastric antrum and corpus showed chronic active gastritis in both of them and H&E stain revealed a large amount of Helicobacter pylori bacteria. Finally, the patient was treated successfully with concomitant therapy for the eradication of Helicobacter pylori (metronidazole 500 mg, amoxicillin 1g, clarithromycin 500 mg and lansoprazole 30 mg, twice a day for 10 days). The eradication was verified via a stool antigen test for Helicobacter pylori, 1 month after treatment. In addition, he took iron supplements, continues to take proton pump inhibitor once a day and has limited the use of NSAIDs. The symptoms were eliminated after a few weeks from the inception of therapy and the hemoglobin was normal after 5 months. Two years later, a follow-up endoscopy revealed that the bridge between the two channels was disappeared and there was only single large opening (). The stomach, duodenum and esophagus were normal. In addition, biopsies were taken from the gastric antrum and body, which showed chronic inactive gastritis, while H&E stain proved to be negative for Helicobacter pylori.
We present a 66-year-old female who presented to surgical outpatient department with mild epigastric pain. She denied any history of peptic ulcer disease or use of ulcerogenic drugs, such as NSAIDs. Clinical examination revealed an otherwise fit patient; the abdominal examination was normal. The endoscopy showed no evidence of peptic ulceration but demonstrated a double pylorus (). The mucosa of the stomach as well as the duodenum appeared normal. The duodenum was easily entered via both pyloric channels. The patient was treated symptomatically and is now well. A follow-up endoscopy 6 weeks later demonstrated the same findings as the initial endoscopy.