Abstract

Periampullary tumors are neoplasms that arise near the ampulla of Vater and may originate from the pancreas, duodenum, distal common bile duct (CBD), or ampullary complex. Timely diagnosis and appropriate surgical intervention often depend on the initial evaluating physician. We present the case of a 60-year-old man who presented to a tertiary care hospital in June 2023 with obstructive jaundice. He underwent CBD stenting, and imaging studies including ERCP and CT scan suggested periampullary carcinoma. A subsequent biopsy confirmed the diagnosis of malignancy. However, due to severe financial constraints and symptomatic relief, the patient was lost to follow-up. Remarkably, he remained clinically stable and active for two years without receiving any oncological treatment. He later re-presented with epigastric pain and nausea. Repeat imaging showed localized disease, and he subsequently underwent a Whipple procedure. Histopathology confirmed stage IIB (pT3b N0) periampullary carcinoma of the intestinal type. The patient received adjuvant chemotherapy with FOLFOX for six months. This case highlights the need for further research into prognostic factors and molecular profiling to better predict survival outcomes in periampullary carcinoma.