Double pylorus and gastroduodenal fistula are uncommon conditions that are either congenital or acquired. Acquired double pylorus in most cases resulted from a penetrating peptic ulcer creating a fistula between the duodenal bulb and the prepyloric antrum. The diagnosis is usually made by endoscopy. Surgical intervention should be only considered for patients with refractory symptoms, recurrent ulcers and other complications. We report the case of a 85-year-old man with an acquired duodenal-antral fistula resulting from a retrograde penetration of an ulcus duodeni and simulating a double pylorus.