Double pylorus (DP) or duplication of the pylorus is an unusual endoscopic finding due to a gastroduodenal extending from the gastric antrum to the duodenal bulb and can be either congenital or acquired. Congenital DP occurs due to gastrointestinal duplication but acquired DP is usually a complication of peptic ulcer disease.

In this article we describe a case of an 85 years old woman presented with hematochezia. Colonoscopy revealed three 10 mm ulcers in the rectum suggesting of solitary ulcer rectal syndrome (SURS). Endoscopy findings indicated a gastroduodenal fistula between the pre-pyloric antrum and second part of duodenum as a double pylorus. This finding was probably the result of an untreated pre-pyloric ulcer. Treatment with proton pump inhibitors (PPIs) started and H.pylori eradication regimen was prescribed. She discharged with good general condition and one month follow up did not reveal any complications.

Spontaneous closure of the fistula occurs in some cases. There is no necessity for surgical treatment unless ocuuring complications or refractory symptoms.