Celiac artery compression due to the median arcuate ligament is a rare but not an uncommon finding in patients undergoing pancreaticoduodenectomy (PD). Due to the interruption of the collateral pathways during surgery, celiac artery compression may be associated with fatal complications.
In this paper, we present three patients with celiac artery compression undergoing PD. In the first case, celiac artery compression was recognized during surgery, but nevertheless the patient died postoperatively because of ongoing Klebsiella sepsis. In the second case, we did not recognize it during initial surgery so further complications could have been avoided. In the third case, compression was detected during PD and the postoperative course was without complications.
Preoperative abdominal CT scan should be evaluated very carefully in order to identify celiac artery compression. Otherwise absence or limitation of blood flow within the common hepatic artery (CHA) during surgery should lead surgeon to suspect presence of compression of the celiac artery.