Superior mesenteric artery syndrome: A very rare condition, with difficult diagnosis, and successful management

Background: Superior mesenteric artery syndrome (SMAS) is a rare condition which is due to intermittent functional obstruction of the third part of the duodenum between the superior mesenteric artery and the vertebral column and aorta. Case Report: We are presenting a 45-year-old woman who presented with persistent vomiting with intermittent epigastric pain which was getting worse over the last eight years. She was misdiagnosed as gastrooesophageal reflux and gastritis on may occasions. Upper gastrointestinal series, endoscopy and biopsy were done followed by abdominal computed tomography (CT) to reach the diagnosis of SMAS. The diagnosis was challenging, and conservative management by medical therapy was not helpful so duodenojejunostomy was carried out, also Billroth's gastrectomy II was done as the antral mucosa showed moderate dysplasia and enteroanastomosis. Conclusions: The operation was successful and the patient was symptom-free in post operative follow up for one year.