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A technique of incisional hernia repair originally devised by da Silva is described. The operation was performed on 30 patients and no recurrence was found in the 27 cases examined 1 to 4.5 (mean 2.5) years later.

Case reportscarries a high degree of morbidity. Distal or subtotal pancreatectomy has also had mixed results, although patients 1 and 2 in this family experienced complete relief of pain after operation. While not advocating distal pancreatectomy for all patients, it is proposed that the procedure be considered when conservative therapy is failing. References I .Comfort Standard surgical texts list several rare causes of acute pancreatitis that should be considered when gallstones and alcohol have been excluded. This list should now also include intraluminal duodenal diverticulum, a congenital abnormality first described by Boyd' in 1845. Case reportA 27-year-old woman was admitted to hospital with acute pancreatitis. During the preceding 7 months she had experienced several less severe episodes of epigastric pain. She did not drink alcohol, had normal serum lipid levels and a normal abdominal ultrasonography scan. Symptoms settled with conservative treatment. Some 2 months later she was readmitted after a more severe attack. Endoscopic retrograde cholangiopancreatography (ERCP) during this admission appeared to show a large polyp in the second part of the duodenum that obscured the papilla, preventing cannulation of the ampulla of Vater. A subsequent duodenogram supported the endoscopic findings (Figure 1 ).At laparotomy 3 weeks later the duodenum was palpably normal but duodenotomy revealed a 7 x 2 cm duodenal diverticulum resembling a 'windsock' and which could be completely invaginated. The neck of the diverticulum was attached to 120" of the circumference of the duodenal wall at the level of the papilla and on the same side of the duodenum. Although the diverticulum was not causing luminal obstruction, when it was collapsed its free edge lay directly over the papilla. The diverticulum was excised along its mural attachment. Microscopically it comprised two layers of duodenal mucosa separated by muscularis mucosa. The patient made an uneventful recovery and after 6 months remains asymptomatic. DiscussionAn intraluminal diverticulum, which is usually found in the second or occasionally the third part of the duodenum, is one of the least common forms of congenital duodenal abnormality. It occurs equally in both sexes. Approximately 50 cases have been reported in the world literature, 40 per cent of which have had coexistent anatomical abnormalities including choledochocele and annular pancreas'. In the 7-week-old normal embryo the duodenum becomes occluded and then recanalized. Incomplete recanalization causes either duodenal atresia, stenosis or a diaphragm3. A duodenal diverticulum, attached to all or part of the circumference of the duodenum, may be caused by ballooning of a diaphragm or may represent the remnant of dual recanalization, a theory postulated to explain its rare occurrence in neonates4.Intraluminal duodenal diverticula most commonly present in the third to fifth decades with abdominal pain and obstructive speculated that reflux of duodenal contents into the pancreatic duct might occur if the am...