Acquired double pylorus due to gastroduodenal fistula complicating peptic ulceration

Fistulous communication between the gastric antrum and the duodenal bulb had the roentgenographic appearance of a double-channel pylorus in five adult patents. A penetrating peptic ulcer was the underlying cause in each instance. Following conservative management, the fistula in two cases closed spontaneously and in two other cases became asymptomatic despite persistence of the accessory channel. The remaining patient underwent subtotal gastrectomy because of hemorrhage from nonhealing antral ulcer.