Background. Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction in children and is often diagnosed late due to nonspecific symptoms and limited awareness. Cases. We report two pediatric cases of SMA syndrome presenting after significant weight loss. The first was a malnourished adolescent with recurrent bilious vomiting in whom diagnosis was delayed due to communication barriers and limited access to imaging; definitive treatment with duodenojejunostomy resulted in excellent recovery. The second child developed acute obstruction following prolonged illness and weight loss; feeding jejunostomy enabled nutritional rehabilitation and complete resolution without the need for definitive bypass surgery. Conclusion. A high index of suspicion is essential for early diagnosis of SMA syndrome in children with upper gastrointestinal obstruction and weight loss. While duodenojejunostomy remains the definitive treatment, feeding jejunostomy may serve as an effective and pragmatic alternative in selected patients, particularly in resource-limited settings.
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