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A case of a 39-year-old woman diagnosed with superior mesenteric artery syndrome after a 25-year history of nausea, vomiting, and abdominal pain that began as a teenager and the absence of any significant weight loss illustrates the diagnostic complexity of this entity, particularly among teenagers and young adults who present with these symptoms. The patient underwent multiple upper endoscopies and serologic evaluations before a contrasted CT demonstrated an acutely angled SMA and duodenal compression, prompting the diagnosis of SMA syndrome. This case underscores the importance of including congenital SMA syndrome on the differential in young people without an obvious cause of persistent nausea, vomiting, and abdominal pain.

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