Superior mesenteric artery syndrome presented with postprandial bilious vomiting successfully treated with open duodenojejunostomy in a resource-poor setting

Introduction: Superior mesenteric artery syndrome is a rare condition which is also known as Willkie's syndrome which is caused by compression of the third part of the duodenum by the superior mesenteric artery. Case presentation A 23-year-old female presented with repeated episodes of abdominal pain and bilious vomiting for five months duration. Vomiting was postprandial about 30–45 minutes after each meal, more with liquid diets. She felt comfortable with the knee-chest position when pain comes. She had no other significant past medical or surgical history. Her body mass index was 17.5 kg/m 2 , and the physical examination was otherwise unremarkable. Her basic laboratory investigations were normal. A subsequent upper oesophagogastroscopy was normal except for reflux esophagitis. The ultrasound scan of the abdomen was normal, however, the CT scan showed duodenal compression at the superior mesenteric artery with proximal dilatation. But the aorto-mesenteric angle was normal. The patient was subsequently subjected to upper gastrointestinal contrast study, demonstrating a duodenal compression third part with delay in contrast passage into the proximal jejunum. The patient opted for interim total parenteral nutrition and underwent retro-colic duodeno-jejunostomy, where the patient showed a dramatic improvement during postoperative follow-up. Conclusions Superior mesentery artery syndrome is a rare disease causing an upper gastrointestinal obstruction where duodeno-jejunostomy stands as a successful treatment option.