Unusual periduodenal fistulas in peptic ulcer disease.

I recognized fistulas between the stomach and descending duodenum and between the duodenal bulb and descending duodenum in three patients by upper gastrointestinal study. The many recent papers on the "double pylorus" together with these three previously unreported examples suggest that periduodenal fistulas are not infrequent complications of peptic ulcer disease. Crohn's disease is unlikely without appropriate history and other radiologic evidence. Congenital duplication is usually noncommunicating and most often occurs at the mid portion of the stomach's greater curvature. Awareness of variety of these fistulas and special effort to demonstrate their presence should help interpretation during endoscopy and radiologic examination.