This is the report of an infant seen on June 25, 1960 with preampullary total duodenal obstruction caused by a combined annular pancreas and duodenal stenosis above the ampulla. A gastroduodenostomy was performed. In December 1989, he fathered a 1,700-g boy with preampullary duodenal atresia. A duodeno-duodenostomy was performed successfully by the same pediatric surgeon. Second-generation duodenal obstruction is rare; to our knowledge, there are no other cases.