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<p>One of the rare cases of the upper gastrointestinal tract obstruction is superior mesenteric artery syndrome (SMAS) but potentially life-threatening if not recognized early. It is due to loss of fat pad between the aorta and SMA which will lead to a compression of the third portion of the duodenum. It has a different angle which will lead to different presentations as well as severity. We are reporting the 15 year-old (y/o) female who is medically free, presented to the emergency department (ED) complaining of severe colicky epigastric abdominal pain for the last 5 days in the epigastric area. The diagnosis of SMAS was made after clinical and radiological investigation. After proper supportive resuscitative measures, definitive management of the surgery was done by laparoscopic approach (duodenojejunostomy). The diagnosis of SMA syndrome is considered challenging due to many presentations and might be confused with other clinical conditions. Unless early diagnosed and treated, the outcome might be catastrophic. Medical treatment is attempted first in many cases depending on the severity and presentation but if failed, surgery will be the best option.</p>

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