Four patients of SMA syndrome presented in the past 3 years. One case was treated surgically and three others were treated conservatively. Although it is rare, strong suspicion is advocated in evaluating patients with long-standing vague abdominal complaints. Diagnosis is made by upper gastrointestinal barium study and SMA angiogram. However, mild distention of the duodenum may be overlooked in barium meal G.I. series. The air inflation test has been of value in recognizing this syndrome. It has been recognized that there are acute and chronic forms. Peptic ulcer is often associated with SMA syndrome, especially in the chronic form. Conservative treatment must be stressed and performed initially. Surgical intervention is indicated if medical treatment fails. Division of the ligament of Treiz to free the bound position of the duodenum and make the duodenojejunal flexure downward is advocated first during surgery. If the result is not satisfactory the duodenojejunostomy is necessary.