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Rupture under the bridge, which way should I go?
João Pedro Pereira, Mara Barbosa, Cátia Leitão, José Soares
Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos
A 61-year-old man with history of alcohol abuse was admitted to the emergency room with gastrointestinal bleeding (melenas) without hemodynamic instability. Lab tests revealed a severe anaemia.
Upper endoscopy revealed a double-pylorus deformity with a 20 mm width ulcer with adherent clot on the way of a antro-bulbar fistula. Underlying the clot a visible vessel was identified. After epinephrine injection one endoclip was applied with hemostatic success.
After 5 days the patient was discharged and a gastroduodenoscopy was scheduled 2 months later.
This reports a rare endoscopic finding of two pyloric ostia leading into the duodenum, also known double pylorus.
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