Celiac axis stenosis in a patient undergoing pancreatoduodenectomy

Celiac axis (CA) stenosis is a commonly detected condition in candidates planned for upper abdominal surgery. In major abdominal surgeries, CA stenosis has its own importance. In our case, a 57-year-old female was admitted with obstructive jaundice and diagnosed to have distal cholangiocarcinoma and was planned for surgery. Computed tomography scan (done from outside centre) was discussed with our radiologist; a moderate-to-severe CA stenosis was noted with collaterals being developed between superior mesenteric and gastroduodenal arteries. Based on this, she was planned for preoperative biliary and vascular stenting before definitive surgery. Whipple procedure was done after stenting of the CA stenosis. Intraoperatively, we found a wide and good caliber hepatic artery being fed by the CA itself. Postoperatively, there was no complication related to ischemia or anastomotic leak. This case is being reported to emphasize the importance of thorough radiological evaluation before taking up any major abdominal surgery.