Congenital Double Pylorus in a Pediatric Patient: Unique Endoscopic Morphology and Clinical Presentation

A 6-year-old girl presented with a 2-month history of intermittent nausea and vomiting. The patient was diagnosed with Helicobacter pylori infection previously, but subsequent eradication therapy ended in failure. Physical examination revealed no significant abnormalities. Endoscopic examination confirmed H. pylori infection and revealed gastric mucosal atrophy. Additionally, a circular lesion (1.5 cm in diameter) resembling a miniature gastric antrum was observed below the pylorus ([Fig. 1]). The boundary of the lesion was clear and surrounding mucosa was smooth and slightly elevated, a 1 to 2 mm sized opening can be seen in the edge of the lesion. Upon aligning the lesion and performing water insufflation under endoscopy, a small amount of liquid accumulation can be seen in the duodenal bulb. The lesion appears to be ectopic pancreas, but our endoscopic biopsy result showed gastric antral mucosal tissue ([Fig. 2]). Based on the characteristics of the patient, we diagnosed the lesion as congenital double pylorus. The child improved and was discharged after symptomatic treatment.

Fig. 1 Endoscopic manifestations of the lesion.

Fig. 2 Pathological histology result of the lesion showed gastric antral mucosal tissue.

Congenital double pylorus which was first reported in 1969 is an uncommon gastrointestinal anomaly, typically presenting in childhood. While cases in adults are often acquired and linked to peptic ulcer disease, congenital cases arise due to developmental abnormalities.

The clinical symptoms of this disease can manifest as chronic or acute upper abdominal pain and/or discomfort, bloating, nausea, vomiting, indigestion, and gastrointestinal bleeding. Diagnosis of the congenital double pylorus mainly relies on endoscopic examination. Gastroscopy is the most intuitive and accurate method and biopsy can be performed during the examination. In this patient, the endoscopic appearance of the lesion initially suggested ectopic pancreas; however, biopsy revealed gastric antral mucosa, leading to the diagnosis of congenital double pylorus. Differential diagnoses include gastric duplication cysts and acquired pyloric fistulas. Treatment was conservative, focusing on H. pylori eradication and symptomatic management. Surgical intervention is rarely indicated, as most cases respond well to medical therapy.[1] [2]

Conflict of Interest

None declared.

Author's Contributions

All authors contributed to writing of the manuscript.

Patient Consent

Patient's written consent was obtained for the publication of the case details.

• References

• 1 Lei JJ, Zhou L, Liu Q, Xu CF. Acquired double pylorus: clinical and endoscopic characteristics and four-year follow-up observations. World J Gastroenterol 2016; 22 (06) 2153-2158
• 2 Hu TH, Tsai TL, Hsu CC, Lu SN, Hsiao M, Changchien CS. Clinical characteristics of double pylorus. Gastrointest Endosc 2001; 54 (04) 464-470

Publication History

Article published online:
28 March 2025