Double pylorus; a complication of gastric ulcer.

A 75-years-old, female patient, who takes non-steroidal antiinflammatory drugs (NSAIDs) frequently due to her arthralgia symptoms, applied to our clinic with the complaints of abdominal pain in the epigastric region. She had endoscopy, which revealed a region with a depressed center at the small curvature side, distal to antrum in the prepyloric region. When this region was forced mildly by the endoscope, an ulcer mouth with a necrotic base and covered by off white exudate was detected (Fig. 1A). Biopsy samples were obtained from this region. Passing through the pylorus canal, it was reached to the bulb, which was normal, but mucosa was edematous and rough at the level of ampulla of Vater in the second region of the duodenum. Although lumen diameter was observed normal, the distal part could not be reached. Malignity was not detected in the biopsy specimens and the patients were positive for Helicobacter pylori (HP), so she received the HP treatment. Proton pump inhibitors (PPIs) are given for 2 months after the HP treatment and the patient had the control endoscopy after the 2 month. In the endoscopy, ulcer was recovered with a large fistula mouth instead of its place (Fig. 1B). As a result of passages from fistula to the bulb directly through pylorus canal, fistula mouth opening to the bulb was observed at the roof of the bulb. Patient is still using PPI and in her control endoscopy, fistula has been observed to be open at the 5 month.