In patients with celiac axis stenosis or occlusion, a pancreaticoduodenectomy procedure can increase the risk of hepato-pancreato-biliary and other organ ischemia or failure unless a complete revascularization of the celiac axis is performed prior to or simultaneous with such surgery. Celiac axis occlusion does not appear to be an uncommon finding in cases of pancreaticoduodenectomy. Preoperative abdominal angiography can play an important role in diagnosing this high risk comorbid disease, and adequate intervention can lead to a successful operation and good postoperative outcome. Herein, we reported a patient with periampullary malignancy and metastatic liver cancer, whose preoperative diagnosis of severe celiac axis stenosis was proved by preoperative abdominal angiography. Preoperative angioplasty was subsequently performed. After angioplasty, pancreaticoduodenectomy with resection of segments 4, 6 and 7 of liver was done and the postoperative course was uneventful.