Two instances of bile reflux without acute pancreatitis.

In two patients in whom most of the bile and the pancreatic juice were mixed, one within the pancreatic duct because of a presumed injury to the ampulla of Vater and the other within the bile duct secondary to a tumor of the ampulla of Vater, there was no pathologic evidence of acute pancreatitis within the pancreas. This was true even though there was chemical evidence that trypsin in its active form passed through the pancreas. On explanation for this is that trypsin inhibitors contained in human bile and pancreatic juice may bind trypsin.