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Celiac compression is usually a benign condition, but when surgery necessitates division of collaterals from the superior mesenteric artery, it may cause life-threatening gut ischemia. We report a case of cholangiocarcinoma necessitating pancreaticoduodenectomy in a patient with celiac artery compression by the median arcuate ligament. Preoperative duplex scanning confirmed the celiac stenosis and...