Introduction Superior Mesenteric Artery (SMA) Syndrome is a rare cause of small bowel obstruction, due to the compression of the duodenum between the abdominal aorta and the superior mesenteric artery. It usually follows rapid weight loss resulting in a lack of retroperitoneal and visceral fat.

Case presentation We report two very different cases of interest, of teenagers who presented to general paediatrics with gastrointestinal symptoms following weight loss. Both were subsequently diagnosed with SMA syndrome and followed a successful refeeding programme through the use of a nasojejunal tube or percutaneous endoscopic jejunostomy tube to bypass the obstruction.

Conclusions These cases highlight the diagnostic difficulties associated with the rare SMA syndrome. Delayed diagnosis can result in complications relating to electrolyte disturbances, bowel obstruction and perforation.