• the patients typically present with symptoms related to biliary obstruction of, Painless jaundice, pruritus, abdominal pain and an increased liver enzyme
• patient subjected to US abdomen and revealed dilated CBD and intrahepatic biliary radicles
• then requested for CT abdomen and pelvis shows; the above-mentioned findings of an ampullary lesion and double duct sign in not displayed here,  A normal-sized pancreatic duct does not exclude the diagnosis of ampullary neoplasm because the ductal caliber will be normal in up to 50% in patients with bile duct obstruction caused by an ampullary tumor
• then endoscopic biopsy of this lesion showed adenocarcinoma of the ampulla of Vater. 
• then lastly subjected to Whipple's operation and the patient is good and underwent follow up

Ampullary carcinoma is a rare malignant tumor originating at the ampulla of Vater, in the last centimeter of the common bile duct, where it passes through the wall of the duodenum and ampullary papilla.