ABSTRACT:

Background:
Ampullary adenocarcinoma is a rare gastrointestinal malignancy often diagnosed early due to biliary obstruction. Pancreaticoduodenectomy (PD) remains the gold standard for curative treatment. Despite technical advances, postoperative complications such as pancreatic fistula and hemorrhage contribute significantly to morbidity and mortality.
Case Presentation:
We report a case of a 68-year-old male with obstructive jaundice secondary to ampullary adenocarcinoma. He underwent PD after preoperative biliary drainage and nutritional optimization. The early postoperative period was complicated by a high-grade pancreatic fistula, followed by intra-abdominal sepsis. On postoperative day 9, the patient developed sudden-onset hemorrhagic shock secondary to portal vein rupture. Despite emergent re-exploration, he succumbed to hemorrhage and multiorgan failure.
Discussion: This case illustrates the fatal potential of delayed hemorrhage due to vascular erosion in the setting of pancreatic fistula. Portal vein hemorrhage, while rare, presents unique surgical challenges and high mortality. Early identification of high-risk patients, vigilant drain monitoring, and timely radiologic or surgical intervention are essential to improve outcomes.
Conclusion: Postoperative pancreatic fistula remains a key driver of delayed hemorrhagic complications following PD. Multidisciplinary surveillance and early intervention are critical to reduce failure-to-rescue in such high-risk scenarios.

KEYWORDS : Ampullary adenocarcinoma, Pancreaticoduodenectomy, Postoperative pancreatic fistula, Portal vein hemorrhage, Surgical complications.

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