A case of double pylorus caused by local injection of hypertonic saline epinephrine solution to hemorrhage from gastric ulcer

摘要

A 59-year-old woman was introduced to our hospital with suspicious of bleeding from upper GI and for evaluation of liver dysfunction. The initial endoscopic examination showed a gastric ulcer with visible vessels on the lesser curvature of antrum. We performed hemostasis with local injection of hypertonic saline epinephrine solution (HSE). The second endoscopic examination performed two weeks later revealed that the center of this ulcer had penetrated into the duodenal bulb forming double pylorus. Although the lesser curvature of antrum is common site of double pylorus, short transition from ulcer to fistula in our case indicates that local injection of HES contributed to the double pylorus formation. There is no report of double pylorus caused by HSE.