Superior Mesenteric Artery Syndrome (SMAS) is a rare cause of duodenal obstruction, that should be suspected in cases of chronic, refractory upper digestive symptoms. Between 2008 and 2016, 39 consecutive patients with chronic gastrointestinal symptoms and a diagnosis of SMAS were prospectively included in the study, in order to describe their demographic, clinical and outcome features. All patients underwent duodenojejunostomy.

Inclusion Criteria (at least 2 of the following):

• severe and frequent upper digestive symptoms (occurring at least once a week), associated to poor quality of life and refractory response to medical treatment;
• a condition of underweight (BMI <18.5 kg/m2) associated with difficulty eating;
• severe complications of SMAS (e.g. gastric perforation, acute pancreatitis, aspiration pneumonia);
• suggestive findings of SMAS at barium swallow;
• diagnostic aortomesenteric angle and distance at CT/MR angiography.

Exclusion Criteria:

• inability to provide the informed consent;
• malignancies;
• bowel motility disorders;
• severe psychiatric illness;
• pregnancy;
• impossibility to perform the required diagnostic workup.