a 65 year old male admitted due to acute abdomen on October 20,2002. An emergency laparotomy revealed an extensive necrosis of the wide range of the small intestine including the duodenum, and a wide resection of the small intestine was performed. Pathological diagnosis was amyloidosis of the small intestine. Postoperatively massive bleeding took place and total resection of the duodenum was performed saving the whole pancreas. Bilio-pancreatic reconstruction was performed by an anastomosis between the opened Papilla of Vater and the ilial mucosa. The postoperative course was uneventful and the patient is alive and well.