Double pylorus associated with systemic lupus erythematosus

A 53-year-old female was admitted to Kyushu University Hospital because of polyarthralgia. A diagnosis of systemic lupus erythematosus was made and treatment with 20 mg~45 mg daily of prednisolone was administered for 3 months, followed by development of gastric ulcer. One year after the episode, the patient had mild epigastralgia. Barium study of upper gastrointestinal tract revealed a fistulous tract that connected the prepyloric region with the duodenal bulb. A diagnosis of double pylorus was established on endoscopic examinations. There were two channels in the pyloric area. An ulcer was observed in the superior one. A plastic tube was placed through the inferior channel (the normal pylorus). The probe could be visible endoscopically through the superior one (the second acquired channel). The acquired double pylorus might be due to penetration of the prepyloric ulcer to the duodenal bulb as a result of long-term steroid therapy.