A 64-year-old patient underwent pancreaticoduodenectomy for adenocarcinoma of the third and fourth portions of the duodenum. The local, but not the aortic, lymph nodes were involved. He has remained well for the subsequent four years. The tumor was not seen on one earlier upper gastrointestinal tract x-ray film and on surgical exploration at another hospital. A careful review of the literature reveals among numerous reports no previous pancreaticoduodenectomy for this lesion, but limited procedures and inadequate documentation of the extent of local and lymph node involvement.