The =duodenum= is opened next. The curved scissors, or the enterotome, is introduced into its lower end through an opening made above the ligature, and the inferior and descending portions of the duodenum are cut in the middle line of the anterior wall. The superior portion is then cut up to the pylorus, the cut passing through the inferior wall of this portion, the enterotome being held in the axis of the canal and pylorus, while the duodenum is pulled over to the right by the left hand. Before the pylorus is cut it should be explored, as to its width or constriction, by the index-finger of the left hand. The duodenum may also be opened first in the lower part of the descending portion. The root of the mesentery is pushed over to the left and a fold of the anterior wall is picked up by the thumb and index-finger of left hand and cut with the shears, so that when let free by the left hand there is formed a longitudinal incision in the duodenal wall large enough to admit the long blade of the enterotome. The duodenum is then cut up to the pylorus as described above. The inferior part of the duodenum is then opened from the point where the first incision is begun. The duodenum may also be opened downward, beginning at the pylorus, a small transverse cut being first made in the stomach wall just above the pylorus and the stomach opened along the greater curvature as far as the cardia. The enterotome is then placed through the pylorus and the duodenum cut in the median line of its anterior wall throughout its entire length. When the duodenum is opened, the _papilla_, the _ductus choledochus_ and the _ductus Wirsungianus_ are to be carefully examined. The papilla can usually be easily found by stretching the duodenal mucosa transversely over the head of the pancreas. It lies below the middle of the head of the pancreas, and about four finger-breadths below the pylorus. Pressure should be made upon the gall-bladder to force bile through the duct and papilla, and thus demonstrate their patency. When this cannot be done a sound should be introduced, and the common duct opened into the hepatic and cystic ducts. If the duodenal mucosa just below the papilla be stretched forcibly downward the duct can usually be opened by the small scissors without the aid of a grooved director. The duct of Wirsung may be explored with the sound from the papilla to the left of the common duct, or from its separate opening when the two ducts do not open in common. Both the bile-duct and the duct of Wirsung may be opened in the opposite direction, from the liver and pancreas respectively.