Malignant tumors which arise in the vicinity of the lower end of the common bile duct are an important cause of obstructive jaundice. These tumors can be classified as follows (Cattell and Warren, 1953):
A. Cancer of the head of the pancreas (50%).
B. Cancer of the ampulla of Vater (30%). Tumors of the ampulla may arise from the ampulla itself, from the joint opening of the common bile duct and the pancreatic duct, or from the overlying duodenal mucous membrane.
C. Cancer of the terminal part of the common bile duct (10%).
D. Cancer of the duodenum (10%).
The surgical approach to obstructive jaundice caused by any of these tumors is a laparotomy, and if a malignant tumor is found, the surgeon has to choose between a palliative and a radical operation. The palliative operation relieves the obstruction of the common bile duct, and although the lifespan of the