Postprandial Vomiting and Abdominal Pain

A 14-year-old Asian female presented with complaints of abdominal pain that was intermittent, crampy, periumbilical, without radiation, and aggravated by eating. She had been vomiting "green-colored" material 4 days earlier, after meals, associated with abdominal pain. On hospital day 3, after no improvement was noted, an upper GI series demonstrated an obstruction at the third portion of the duodenum. She was evaluated for an eating disorder, but further history failed to elicit diagnostic criteria. She responded favorably to total parenteral nutrition and symptoms were relieved with changes in position. Her symptoms and diagnostic studies were consistent with the diagnosis of superior mesenteric artery (SMA) syndrome.