Ampulla of Vater Metastasis From Colon Cancer Presenting As Obstructive Jaundice.

A woman in her late 60s presented with obstructive jaundice. She had mucinous adenocarcinoma of the colon six months ago and underwent surgery followed by adjuvant chemotherapy. A computed tomography scan revealed a prominent ampulla with duodenal wall thickening, dilated intrahepatic biliary radicles, bile ducts, and the main pancreatic duct. Duodenoscopy revealed a bulky, friable, and ulcerated ampulla of Vater (AOV) with partial luminal narrowing. The biopsy and immunohistochemistry (IHC) confirmed adenocarcinoma of colonic origin metastasizing to the AOV. She underwent an endoscopic retrograde cholangiogram and biliary drainage, and best supportive care before dying of her illness. Metastatic involvement of AOV is extremely rare. This case reiterates the need to consider AOV metastasis in the differential diagnosis of obstructive jaundice, especially in patients with a history of malignancy. It also underscores the role of IHC to differentiate AOV primary malignancy from metastasis.