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Pancreaticoduodenectomy (PD) is the treatment of choice for malignant and some benign diseases of the pancreas and periampullary region. Common complications after PD include delayed gastric emptying, pancreatic fistula, anastomotic leak, and intra-abdominal collection. Postoperative medical complications include arrhythmia, renal failure, pulmonary complications, urinary tract infection, and deep vein thrombosis. Superior mesenteric artery (SMA) thrombosis is rarely been reported after PD. SMA thrombosis is difficult to diagnose in postoperative period due to nonspecific symptoms and associated with high mortality rate up to 80%–90%. The patient was a 68-year-old female with lower end cholangiocarcinoma without any other comorbidity. She underwent PD without any intraoperative complications. Postoperatively, she developed SMA thrombosis. Unfortunately, the patient could not be salvaged, and she succumbs to death.