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During 4,528 operations on the biliary tract 216 cases showed proof of acute pancreatitis. In 153 instances hemorrhagic and necrotic pancreatitis was diagnosed. Pressure and flow measurements in the choledochus allow us to distinguish 3 categories: Immediate surgery (14) demonstrated marked oedemes of the duodenum at the papille of Vater (twice "cocarde" sign) with sustained high pressures and cascade-like flow. Operations 72 to 96 hours past the onset of pancreatitis (68) demonstrated intolerance duodenal anti-peristaltic waves and reflux into the enlarged Wirsung under physiological pressures (20 cm). Cases operated 8 days past the onset (71) showed under pressures (+/- 10 cm) massive and permanent reflux into the canal of Wirsung with low residual pressures and images representative of low duodenal tone. A single case of massive pancreatitis necrosis showed visualisation of the entire pancreatic ductal system under low pressure. The mechanism of reflux is discussed.