Duodenum is the second most commonest site after the esophagus to be affected by scleroderma. Imaging finding is characterize by gastric dilatation and delayed emptying with marked dilatation of the D2 and D3 segment of the duodenum. As the D3 segment cross the physiologic narrowing between the SMA and the vertebral body, the slow transit is further delayed resulting in proximal bowel dilatation. The clinical symptoms, proposed mechanism and imaging appearance overlap with the superior mesenteric artery syndrome. Whether there a common or separate pathogenesis exist between the two condition remained to be elucidated.