Superior Mesenteric Artery Syndrome (SMAS) or Wilkie's disease is a rare form of obstruction of the transverse part of duodenum entrapped between superior mesenteric artery and abdominal aorta. SMAS presentation is usually non-specific and poses a diagnostic dilemma. A case of 45 year old asthenic male with no prior surgical history presented to emergency department with epigastric mass, post prandial epigastric pain and intractable vomiting for four months with significant weight loss. On

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... logical investigations diagnosis was made and consistent with SMA syndrome. Patient was managed conservatively for two weeks, as symptoms persisted duodenojejunostomy was performed and patient was relieved of obstructive symptoms and showed satisfactory nutritional improvement in follow up. SMA syndrome should be considered as possible etiology of small bowel obstruction in specific set of patients.