Unexpected finding of arc of Buhler with celiac artery stenosis during workup for a suspected pancreatic lesion

Knowledge about normal and pathological anatomical variants is a key point for all surgeons to perform safe procedures and manage unexpected findings. One example of this is vascular anomalies involving the celiac and superior mesenteric arteries (CA and SMA) and their anastomoses. During a routine workup of a suspected calcified pancreatic lesion, an asymptomatic arc of Buhler was found, connecting the CA and SMA, with 90% stenosis of the celiac trunk. This embryological variant, despite being a rare occurrence, has significance in various surgical procedures, including pancreatoduodenectomy, liver transplantation and interventional radiological procedures, such as gastroduodenal artery ligation and embolisation.