The leakage of pancreatic juice is a very serious complication in the early postoperative course of the gastrectomized patient. Martin,1 reporting on some 520 consecutive gastrectomies, found one true pancreatic fistula, which was fatal, and five pancreaticoduodenal fistulas, four of which were terminated by death.
Bonniot,2 discussing the etiology of this type of fistula, suggests that at least some may be pancreatic in origin. He points out that it is practically impossible to resect a posterior duodenal ulcer without at least minimal damage to the pancreas. Minor damage to some acini may result in leakage of pancreatic juice around the duodenal stump with consequent digestion of the suture line. In discussing the same problem, Lahey,3 Bartlett,4 and Cedermark5 have presented anatomical evidence that direct damage to the main excretory ducts of the pancreas is very likely to occur in difficult dissections of posterior penetrating ulcers.