LAUSR

The double channel pylorus sign refers to the fluoroscopic appearance of a gastroduodenal fistula where two distinct channels between the gastric antrum and duodenal bulb are outlined by barium (Fig. 1). Like a river with a double arched bridge (Fig. 2), the flow of barium is split into two openings separated by a septum of tissue. Unlike in our case, the fistulous tract is generally present superiorly along the lesser curvature aspect of the antrum and is connected to the superior fornix of the duodenal bulb [1]. The double channel pylorus was first described in the 1842 by Mohr [2, 3] and was thought to represent the formation of a fistulous tract adjacent to the native pyloric passageway occurring in the setting of penetrating peptic ulcer disease. This remains the dominant etiology to this day. Rarely, however, the same appearance may