MEHMET SUAT YALÇIN, Şehmus ÖLMEZ, ADNAN TAŞ

Nadir bir Endoskopik Bulgu: Rektum Kanserli Hastada Çift Pilor

Çift pilor antrum ve bulbus arasında kısa aksesuar bir kanalın oluşmasıdır. Mide antrumundan bulbusa uzanım gösteren iki lümen gözlenir. Çift pilor endoskopide %0.06-0.4 sıklıkta oldukça nadir görülür. Asemptomatik olabileceği gibi epigastrik ağrı, dispepsi ve gastrointestinal kanama ile bulgu verebilir. Ellibeş yaşında erkek hasta uzun süredir mevcut olan dispeptik yakınmalar ve karın ağrısı şikayetleri ile kliniğimize başvurdu. Hastanın özgeçmişinde rektum kanseri nedeniyle operasyon öyküsü, kemoterapi ve radyoterapi alma öyküsü vardı. Endoskopide antrumdan bulbusa uzanım gösteren iki lümen izlendi. Lümenin birinden geçildi. Diğer lümenden geçilemedi. Bu nedenle gastrokolik fistülü dışlamak amacı ile baryumlu mide-duodenum grafisi çekildi. Baryumlu mide-duodenum grafisi normal saptandı. Hastada çift pilor tanısı konuldu. Bizim olgumuz literatürde kolon kanserli hastada saptanan ilk çift pilor olgusudur.

A Rare Endoscopic Finding: Double Pylorus in Patient with Rectal Cancer

Double pylorus is a rare abnormality characterized by formation of a short accessory canal between antrum and duodenal bulb. It has been reported in 0.06-0.4% and often discovered incidentally at endoscopy. It can be asymptomatic or present with upper abdominal pain, dyspepsia and gastrointestinal bleeding. Fiftyfive-years-old male patient admitted to our clinic with dyspeptic complaints and upper abdominal pain. The past medical history of the patient included an operation, chemotherapy, radiotherapy due to rectum cancer. An endoscopy revealed two lumens located in prepyloric antrum. Endoscopy could pass through one lumen but could not go thorough the other smaller lumen. Since we cannot go through one of the lumens, barium stomach duodenography of the patient was taken. Barium stomach duodenography of the patient was nondiagnostic. The final endoscopic diagnosis was double pylorus. Here, we report a first case of double pylorus with rectal cancer.

PDF

___

Smith VM, Tuttle KW. Gastroduodenal (pyloric) band. Endoscopic findings and first reported case. Gastroenterology 1969; 56: 331-6.
Hegedus V, Poulsen PE, Reichardt J. The natural history of the double pylorus. Radiology 1978; 126: 29-34.
Kothandaraman KR, Kutty KP, Hawken KAS, Barrowman JA. Double pylorus-in evolution. J Clin Gastroenterol 1983; 5: 335-8.
Lee S-Y, Kim E-S, Cho Y-S. Gastrointestinal: Acquired double pylorus; long term endoscopic observation. J Gastroen Hepatol 2012; 27: 413.
Wiseman SM, Tan D, Hill HC. Double pylorus: an unusual endoscopic finding. Endoscopy 2005; 37: 277.
Czajkowski A, Rosołowski M, Lukaszyk A. Double pylorus: strong evidence for the acquired etiology of this rare abnormality. Endoscopy 2007;39 Suppl 1:E84.
Christien G, Branthomme J M, Volny L et al. Pylore double: Malformation congenitale. Sem Hop 1971; 47: 1485-8.
Hu TH, Tsai TL, Hsu CC, Lu SN, Hsiao M, Changchien CS. Clinical characteristics of double pylorus. Gastrointest Endosc 2001; 54: 464-70.
Naidoo R, Singh B. Congenital double pylorus. Case Rep Gastrointest Med. 2012; 2012: 537697.
Forbes N, Al-Dabbagh R, Lovrics P, Morgan D. Gastrocolic fistula: A shortcut through the gut. Can J Gastroenterol Hepatol 2016; 2016: 6379425.
Vergara-Fernández O, Gutiérrez-Grobe Y, Lavenant-Borja M, Rojas C, Méndez-Sánchez N. Gastrocolic fistula secondary to adenocarcinoma of the transverse colon: a case report. J Med Case Rep 2015; 9: 263.
Jie Yin, Zhi Zheng, Jun Cai et al. Current diagnosis and management of malignant gastrocolic fistulas: a single surgical unit’s experience. Int J Clin Exp Med 2014; 7: 4123-30.