Study design: Case report. Objective: To report on the need to consider the possibility of the superior mesenteric artery syndrome (SMAS) even after a long time from the initial spinal cord injury. Setting: Ulsan, South Korea. Methods: A 41-year-old man with complete tetraplegia was evaluated for nausea and vomiting. He had a cervical cord injury 11 years previously and his body mass index was 18.6 on admission. The contrast-enhanced abdominal computed tomography (CT) showed intestinal obstruction at the third-portion of the duodenum. With frequent position change and intravenous electrolyte support, the symptoms resolved. There was no relapse of the symptoms with some lifestyle modifications. Conclusion: Patients with spinal cord injury may develop SMAS even long after their initial injury.