A 55 year old male presents with features of Obstructive Jaundice. He also repos a weight loss of seven kilograms in last two months. On CT scan, the CBD is dilated till the lower end and the main pancreatic duct is also dialated. Pancreas is normal. The most likely diagnosis is -

Ans. is 'd' i.e., Periampullary carcinoma Old age with significant loss points towards a neoplastic etiology Dilatation of both CBD and pancreatic duct is a strong evidence in our of Periampullary ca. Periampullary Ca includes a group of malignant neoplasms arising at or near the ampulla of Vater. Because of this common location they require similar management for both curative resection (pancreaticoduodenectomy) and palliation. It includes: - Pancreatic head cancer (most common) - Ca of distal CBD - Cancer of the ampulla of Vater - Ca of duodenum The early symptoms of periampullary carcinomas are usually vague and include anorexia, weight loss, abdominal discomfo and nausea. Specific symptoms usually develop only after invasion or obstruction of a nearby structure. These are jaundice and pain. Since periampullary ca, by definition, arises near the distal biliary tree, obstructive jaundice is the hallmark presentation. Jaundice is progressive and often is associated with significant pruritis. Duodenal obstruction may occur in late cases.