Date Posted: June 10, 2026

Author/s: Hannah Celene O. Hernandez, MD

The ampulla of Vater, a common channel for biliary and pancreatic secretions, is where periampullary cancers develop. Identifying their anatomical source, the transitory nature of this area, its proximity to other structures and anatomical variances make up the diagnostic struggle with these tumors. The rarest of them all, primary ampullary adenocarcinoma, has the best chance of survival even in advanced illness and has the highest rate of potentially curative resection. Four to six cases per million, or 0.5% of all gastrointestinal and 7% of all periampullary cancers, are reported annually. Locating the level, extent and origin of obstruction and differentiating benign from malignant causes are the challenges in the diagnosis of obstructive jaundice. In order to identify the causes of blockage, imaging is crucial. The gold standard in exploring the biliopancreatic tract is ERCP. Due to high complication rates linked to it, a less invasive, safe, and highly sensitive diagnostic procedure is urgently needed for patients with suspected bile duct or pancreatic duct anomalies. Magnetic resonance cholangiopancreatography (MRCP) is a recently described, completely non-invasive technique that produces projectional images similar to those obtained with ERCP without the use of contrast agents. It became the standard technique of noninvasive investigation of the biliary tree to visualize intraluminal filling defects, ductal dilatation and strictures. In this report, the author aimed to present the case of an elderly male patient who presented with blood streaked stool and jaundice. During his workup, which included contrast enhanced CT scan of the whole abdomen and MRCP, he was found to have dilated intrahepatic and extrahepatic ducts, and intraluminal thickening in the ampullary region. ERCP and tumor biopsy confirmed the diagnosis of ampullary adenocarcinoma.

Keywords:
Ampulla of Vater, ampullary adenocarcinoma