Pancreaticoduodenectomy for ampullary adenocarcinoma performed in a conflict-zone field hospital during an active armed conflict: a case report.

BACKGROUND: Ampullary adenocarcinoma is a rare periampullary malignancy for which pancreaticoduodenectomy (the Whipple procedure) represents the only potentially curative surgical intervention. This complex operation is universally performed in high-volume tertiary hospitals with dedicated hepatopancreatobiliary surgical teams and a full intensive care infrastructure. We report the first documented case of a Whipple procedure performed in a field hospital in an active conflict zone. CASE PRESENTATION: A 58-year-old male presented with a three-month history of painless obstructive jaundice to a conflict-zone field hospital in Gaza during the armed conflict. CT imaging demonstrated a dilated common bile duct (2 cm) with ampullary-level tapering and moderate intrahepatic biliary dilatation. Endoscopic retrograde cholangiopancreatography confirmed a tumorous ampulla; biliary stenting and biopsy were performed, with histopathology confirming well-differentiated ampullary adenocarcinoma. Given the complete absence of tertiary referral options due to the destruction of hospital infrastructure, a pancreaticoduodenectomy was performed under field-hospital conditions (admission 20 July 2025, discharge 28 July 2025). Final histopathology confirmed well-differentiated ampullary adenocarcinoma, pT1a N0, with the tumor limited to the sphincter of Oddi, all margins negative (R0), and 0/14 lymph nodes involved. At discharge on postoperative day 8, the patient was clinically well, with a clean wound, a soft abdomen, and acceptable laboratory values. Four-month follow-up CT demonstrated a clear operative bed with no local recurrence, no regional lymphadenopathy, and no distant metastases. CONCLUSION: This case demonstrates that a technically demanding, curative-intent Whipple procedure can be successfully performed in an active conflict-zone field hospital, achieving oncological outcomes equivalent to high-volume centers. It represents a notable advance in humanitarian surgery and underscores the importance of surgical expertise in austere environments.