Double pylorus in an elderly female patient: a case report

Double pylorus, or acquired gastroduodenal fistula, is a rare endoscopic finding, reported in only 0.001-0.4% of upper gastrointestinal examinations. We describe a case of acute gastrointestinal bleeding associated with a double pylorus in an elderly patient.

A 78-year-old white woman recovering from a pelvic ring fracture was admitted to a rehabilitation unit and received prophylactic dalteparin. She had no prior history of peptic ulcer disease or gastritis. After 2 weeks, she developed acute weakness, abdominal discomfort, nausea, and vomiting, accompanied by a 2.9 g/dL drop in hemoglobin. Urgent upper endoscopy revealed a double pylorus, and biopsy confirmed Helicobacter pylori infection. We reviewed published clinical reports of double pylorus. Most patients were older adults, and abdominal pain or gastrointestinal bleeding were frequent presenting symptoms. Use of nonsteroidal anti-inflammatory drugs or corticosteroids and the presence of Helicobacter pylori infection were commonly reported among described cases, although the quality and completeness of available data varied.

Double pylorus is a rare but clinically relevant condition that may first be detected when complications such as gastrointestinal bleeding occur. Reported associations with H. pylori infection and nonsteroidal anti-inflammatory drug exposure represent observational trends rather than established causal relationships, as the evidence remains heterogeneous and limited. The condition likely develops in the setting of multifactorial impairment of gastroduodenal mucosal integrity, particularly in older or medically vulnerable individuals.