Abstract
A 69-year-old male visited our hospital with complaints of melena and hematemesis. He had been treated with corticosteroid for 10 years because of rheumatoid arthritis. The first endoscopic examination showed a gastric ulcer with blood clots on the lesser curvature of the prepyloric region. Two weeks later at the second endoscopic examination, this lesion was found to become deeper. The third endoscopic examination performed six weeks later revealed a healed gastric ulcer and an accessory opening on the lesser curvature near the pylorus. Upper GI series also disclosed a gastroduodenal fistula communicating between the lesser curvature of the prepyloric region and the duodenal bulb. The fourth endoscopic examination carried out two months later revealed a small ulcer at the pyloric septum. Three months later at the fifth endoscopic examination, seven months after the initial endoscopic examination, the double pylorus had fused and formed a large single pylorus. Of 61 cases of double pylorus reported in Japan, only five cases developed a fused single pylorus. This case was very rare, because repeated endoscopic examinations could observe the whole process of a double pylorus leading to the fusion.
