[Double pylorus and pyloroduodenal fistulas: two case reports and discussion]

Congenital double pylorus is extremely rare; only 2 cases have been found in the English and French literature. Acquired double pylorus occurs more often; up to 1982, 66 cases had been reported. During 6 810 consecutive barium meal examinations over a period of 2 years, we diagnosed the condition in 5 patients. Two came to operation, at which the diagnosis was confirmed. These 2 cases are described. Acquired double pylorus is in reality a short pyloroduodenal fistula situated next to the pylorus, usually on the lesser curvature side. In the majority of cases it results from a pyloric ulcer penetrating into the duodenum. In a minority of cases the primary lesion is a duodenal ulcer penetrating into the pyloric area. Cases initially present with peptic ulcer symptoms. With the formation of the fistula, symptoms may disappear. Some authorities consider this to indicate spontaneous cure of the ulcer, thus obviating the need for further medical or surgical treatment. In the present 2 cases there was no remission of symptoms. None of the cases has been associated with malignant disease. It is thought that the condition may be recognized more often in future.