Superior mesenteric artery syndrome is a relatively rare but known condition that may affect children. This condition can be managed conservatively and that with nutrition hence avoiding major surgical intervention. A previously fit 13-year-old boy presented with non-bilious vomiting that had turned bilious, over 5 days makingsub-acute intestinal obstruction likely. Barium meal and follow-through were conclusive of superior mesenteric artery syndrome (SMAS) which was confirmed with a CT abdomen. He was managed with parenteral nutrition and positioning when taking oral feeds. He made a full recovery and demonstrated weight gain and continued to remain well without vomiting on follow up. Although a rare condition, SMAS should be considered in children with acute vomiting which can be managed conservatively as highlighted by this case without any known precipitating causes. The medical condition of SMAS is a known yet underused treatment which may avoid major intraabdominal surgery. In cases such as our parenteral nutrition was used as a rescue treatment and enteral nutrition followed recovery and convalescence.