A patient presenting with abdominal pain was initially thought to have chronic pancreatitis. Investigation revealed normal pancreatic structure but an indirect test of exocrine function showed low enzyme activity. The true diagnosis of chronic small intestinal ischaemia was demonstrated angiographically and confirmed at laparotomy. The early distinction between chronic pancreatitis and chronic small intestinal ischaemia is important because ischaemia may be the harbinger of acute and possibly fatal bowel infarction. Direct stimulation tests of pancreatic function showing normal results should turn attention to the possibility of small bowel ischaemia.