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Wilkie's syndrome or superior mesenteric artery (SMA) syndrome is a rare etiology of duodenal obstruction due to compression of the third portion of the duodenum between the superior mesenteric artery and the aorta. The aorta–SMA angle ranges from 38° to 65° and the distance between the two is 10-28 mm. The main anatomical feature of SMA syndrome is the narrowing of the aorta–SMA angle to < 25° and a decrease in the aortomesenteric distance < 10 mm, causing the specific duodenal obstruction symptoms. A 17-year-old female presented in our outpatient clinic with persistent epigastric pain, early satiety, pyrosis, and weight loss (cca. 8 kg) in the last year, that had worsened at the time of presentation. An abdominal ultrasound (US) was performed after 14 hours of fasting. It revealed gastric dilatation suggesting upper gastrointestinal outlet obstruction. We admitted the patient to our hospital where we performed gastric decompression via a nasogastric tube. Blood work was unremarkable. The abdominal computer tomography (CT) suggested duodenal stenosis, while the upper gastrointestinal endoscopy revealed mild gastritis and esophagitis without an obvious obstruction. SMA syndrome was included as a differential diagnosis and we performed another abdominal ultrasound, this time measuring the angle between the aorta and SMA which was 17°, and the distance between the two was 5 mm. We also asked the radiologist to perform the same measurements on the abdominal CT performed earlier and the results were compatible with our US findings. Thus, we establish the diagnosis of SMA syndrome, and the patient was managed conservatively. Results In this case, the abdominal US has proven to be the most useful tool in establishing the diagnosis and we suggest routine measurement of the aorta-SMA angle and distance in cases suggesting upper gastrointestinal obstruction. [ABSTRACT FROM AUTHOR]