Spontaneous Gastro-duodenal Fistula

Gastroduodenal fistulae and double pyloric canal

“…The cases Gould [6] reviewed have not been included, as they were not reported in detail. However, he comments in his paper that male patients predominated, the duration of symptoms ranged from 2 to 38 years, and clinical presentations were not unusual for gastric ulcer.…”

“…The average age was 61 years. Pain and epigastric discomfort were the presenting symptoms in all cases and gastrointestinal hemorrhage in nine cases, man- [ 1 4 , 8], one from the lesser curve of the body of the stomach to the duodenal bulb [6], and one in which two gastric ulcers were connected by a mucosa lined channel (gastro-gastric fistula) [4]. A fistula into the inferior fornix of the duodenal bulb from a pyloric ulcer has also been reported [4].…”

“…Although early reports suggest that double pylotus is a congenital lesion [6], recent reports [1,2,8] have documented that antral ulceration precedes the formation of a double pyloric canal. Engle [3] suggests, from sporadic personal communications, that the entity occurs quite frequently.…”

“…Gould [6] described a case of fistula between the lesser curve of the body of the stomach and the duodenum, and reviewed 19 similar cases. Fourteen of these cases were to the duodenal bulb (Type I), the remainder to the fourth part of the duodenum (Type II).…”

Gastroduodenal fistula in the Zollinger-Ellison syndrome

“…There have, however, been a number of recent case reports referring to this problem, sometimes termed 'the double pylorus' (Gould, 1961;Bennike and Hegediis, 1976;Hunt, Day and Jewell, 1978;Rappoport, 1978). These reports may reflect the greatly increased use of diagnostic upper gastro-intestinal endoscopy.…”