The superior mesenteric artery syndrome is a compression of the duodenum. We believe that the diagnostic limitations of the routine barium meal studies can be abolished by hypotonic duodenography. Before surgical treatment other pathological conditions should be excluded. Peptic ulcer disease often coexists. Patients with persisting signs and symptoms after surgery for ulcer should be re-examined with this condition in mind. The adequate treatment is duodenojejunostomy.