[The disinsertion of Vater's papilla in stomach resection. Causes, diagnosis and therapy]

Based on the experiences of our own with two papillary disconnections during partial gastric resection and 105 reports of the world literature (1916-1980), the cause, diagnosis and management of the injury is described. The most important factor favouring the operative accident is the foreshortening of the duodenum caused by the scarring of a chronic postbulbar ulcer. The ampulla of Vater may, therefore, be brought closer to the pylorus. The prognosis of the injury is not determined by the time of discovery, but it depends on the complete diagnosis of both severed ducts and adequate treatment. On delayed recognition the lesion may masquerade leaking of the duodenal stump. Successful repair can be achieved by reimplantation or invagination of the transsected common bile and pancreatic duct into the duodenal stump or an isolated Roux-en-Y-loop.