An unusual complication of peptic ulcer disease.

摘要

A 91-year-old woman with a 10-year history.of gouty arthritis presented with intermittent epigastric pain and bloating of 3 months' duration. Examination was unremarkable except for iron deficiency anemia. Four years prior, a prepy-loric antral ulcer was found on EGD during evaluation for melena (A); in the interim, she had been asymptomatic. Three-dimensional CT by using a LightSpeed 64-detector row CT scanner (GE Medical Systems, Milwakee, Wise) showed two communications between the stomach and the duodenum. The images were reconstructed by using an Advantage workstation to create a 3-dimentional fly-through image, and revealed two pyloric openings (B). A barium contrast study revealed two separate streams of barium from the antrum into the duodenum (C). EGD confirmed a normal pyloric opening with a gastroduodenal fistula above it (D). Histology of the septum of double pylorus demonstrated chronic gastritis without Helicobacter pylori.