Background: Spontaneous perforation of peri-ampullary duodenal diverticula is rare but life-threatening. Evidence guiding operative management is scarce, and consensus is lacking. While surgery is reserved for unstable or complicated cases, pancreaticoduodenectomy (PD) should be preferred in haemodynamically stable patients with free perforation or significant intra-abdominal contamination, rather than temporising measures. Duodenal diverticula are saccular outpouchings of intestinal mucosa and submucosa that extend beyond the muscularis propria. Peri-ampullary diverticulum are uncommon and most cases of PAD are asymptomatic, although around 5% will undergo complications (Chen et al, 2021). Perforation is the most rare and serious complication of duodenal diverticula. Aim: To highlight emergency PD as a definitive and under-reported surgical option for the management of perforated peri-ampullary duodenal diverticula. Case: A 64-year-old female presented to the emergency department with acute onset abdominal pain. CT demonstrated a perforated peri-ampullary duodenal diverticulum. Given the anatomical proximity to the ampulla and degree of contamination an emergency PD was performed. Results: Definitive source control was achieved with emergency PD. The postoperative course was uncomplicated, with no major morbidity. The patient was discharged on postoperative day 12 and remained well on 30- and 90-day follow-up. Conclusion: Emergency PD is a feasible and life-saving option for perforated PAD when lesser procedures cannot provide durable control. Our work contributes to the limited literature supporting emergency PD in this high-risk scenario. References: Chen, Q., Zhang, Y., Tang, Z., Yu, M., Liu, Z., Zhou, X., Li, G., Chen, Y., & Zhou, X. (2021). The role of periampullary diverticulum on the incidence of pancreaticobiliary diseases and the outcome of endoscopic retrograde cholangiopancreatography. Arch Med Sci, 17(4), 905-914. https://doi.org/10.5114/aoms.2020.94591