Whipple’s Procedure Complicated by Celiac Artery Stenosis: Case Report and Review of Treatment Options

Although infrequently symptomatic, celiac artery stenosis is a vascular pathology that can commonly be encountered in hepatobiliary surgery. Secondary to celiac artery stenosis, the supramesocolic viscera may rely on blood supply from the gastroduodenal artery which, if ligated, can lead to detrimental ischaemia causing postoperative morbidity and mortality. We report the case of a 53-year-old female scheduled to have a pancreaticoduodenectomy and an asymptomatic extrinsic celiac artery stenosis identified during preoperative imaging workup. The stenosis was significant, with confirmed retrograde flow in the gastroduodenal artery. Pre-operative endovascular management was considered, but surgical management was preferred due to the young age of the patient and the non-atherosclerotic nature of the stenosis. In conclusion, the release of extrinsic compression on the celiac artery lead to a safer and less complicated procedure, eliminating the need for vascular reconstruction or endovascular intervention.