Hi,Dear,Thanks for your query to HCM. Dear I read facts of your query and reviewed it in context to your health issues submitted. I understood your health concerns and feel Concerned about them. You need to investigate for SMA-(Superior Mesenteric Artery)Syndrome- and plan for Duo-deno-jejunostomy/Gastro-jejunostomy bypassing the duodenal obstruction-/or lysis of ligament of treitz-(Strong s Procedure)for proper nutrition for long term body weight gain. TPN(Total parenteral Nutrtition) is not the permanent way out on SMA Syndrome- in your daughter. This condition causes gastric pain and abdominal bloating and malnutrition.This is because of angulation of the Superior Mesenteric Artery-which causes compression of the transverse duodenum with partial or sometimes total obstruction like syndrome. Review of the other causes is needed for proper treatment in your case. Remedy- IN the given scenario, I would suggest you to investigate with proper USG abdomen CT Contrast study of upper and lower GI system and CT-abdominal-angiography to fix SMA and degree of duodenal obstruction Second opinion from other GI Surgeon/ Radiologist would be needed. Get Second opinion with GI Surgeon/ Radiologist- to rule out other causes as discussed above.Operative procedure would fix your daughter s health issue of weight gain with SMA. Just don t worry and be patient and co-operate with your doctors,till you verify with your attending doctors. Hope this would help you to treat your health issues in the best way possible. Welcome for any further query in this regard to following link- http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229 Wishing Good Healthy Life!! Dr.Savaskar M.N. Senior Surgical Specialist M.S.Genl-CVTS