Double pylorus or antro-bulbar fistula

Area of Science:

• Gastroenterology
• Endoscopic Imaging
• Anatomical Variations

Background:

• Rheumatoid arthritis and gastric ulcers are common conditions.
• Pyloric anatomy can present with rare variations.
• Endoscopic examination is crucial for diagnosing upper gastrointestinal abnormalities.

Observation:

• A patient with rheumatoid arthritis and a gastric ulcer presented with a double pylorus during endoscopy.
• Follow-up endoscopy after one year revealed the fusion of the two pyloric apertures.
• The fused structure resembled a deformed pylorus.

Findings:

• The study documents the endoscopic progression of a double pylorus to a fused, deformed pylorus.
• This rare anatomical anomaly highlights the dynamic nature of the upper gastrointestinal tract.
• The lesion's evolution suggests a potential for acquired development.

Implications:

• The findings suggest that a double pylorus may represent a transient or evolving condition.
• Reclassifying this finding as an antro-bulbar fistula could improve diagnostic clarity.
• Further research is needed to understand the etiology and clinical significance of antro-bulbar fistulas.