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Case Reports
. 2024 Mar 25;86(6):3627-3630.
doi: 10.1097/MS9.0000000000001983. eCollection 2024 Jun.

A successful management of Candy Cane syndrome post Roux-en-Y gastric bypass: a rare case report

Youssef Ahmad  1 , Qamar Sleman  1 , Umer Siddiqui  2 , Sandra Cuevas  3 , Gurkiran Gill  4 , Fadi Souleiman  5
Affiliations
Case Reports

A successful management of Candy Cane syndrome post Roux-en-Y gastric bypass: a rare case report

Youssef Ahmad et al. Ann Med Surg (Lond). .

Abstract

Introduction and importance: Candy Cane syndrome (CCS) is a rare condition in which the proximal gastrojejunal attachment's afferent blind limb is elongated. This can lead to different symptoms, including nausea and vomiting, with less commonly described reflux and regurgitation symptoms.

Case presentation: A 38-year-old female presented with a chronic complaint of postprandial pain, discomfort, and reflux lasting for about 2 years after a previous Roux-en-y gastric bypass (RYGB) surgery. Upper endoscopy was done and raised suspicion for CCS. The patient underwent an exploratory laparoscopy, which confirmed the diagnosis. Surgical resection of the afferent limb was done, and all symptoms were completely resolved at the postoperative follow-up.

Clinical discussion: CCS is considered a rarely described complication that can occur after RYGB gastric bypass surgery. Diagnosing this condition includes performing upper gastrointestinal (GI) studies and endoscopy, which reveal a redundant afferent limb. Laparoscopy serves as a dual-purpose tool, confirming the diagnosis of CCS and providing a definitive curative intervention. Surgical resection has a high success rate, with evidence supporting its efficacy in relieving symptoms.

Conclusion: As the popularity of Bariatric surgeries rises, it is crucial to consistently consider CCS, despite its rarity, as a potential complication. Although diagnosing CCS can be challenging, physicians should maintain a high index of suspicion, especially in patients presenting with upper GI symptoms following metabolic surgeries.

Keywords: Candy Cane syndrome; Roux-en-Y gastric bypass; bariatric surgery; case report; laparoscopy.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article

Figures

Figure 1
Figure 1
(A) Blind afferent limb loop. (B) Gastrojejunal anastomosis.
Figure 2
Figure 2
Black arrow indicating the long blind afferent loop measuring between 11 and 12 cm after dissecting the surrounding tissues.
Figure 3
Figure 3
Black arrow indicating the resecting site of the long blind loop, white arrow indicating normal gastrojejunal anastomosis.
See this image and copyright information in PMC

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References

    1. Kamocka A, McGlone ER, Pérez-Pevida B, et al. . Candy cane revision after Roux-en-Y gastric bypass. Surg Endosc 2020;34:2076–2081. - PMC - PubMed
    1. Khan K, Rodriguez R, Saeed S, et al. . A Case series of candy cane limb syndrome after laparoscopic Roux-en-Y gastric bypass. J Surg Case Rep 2018;2018:1–3. - PMC - PubMed
    1. Aryaie AH, Fayezizadeh M, Wen Y, et al. . Candy cane syndrome: an underappreciated cause of abdominal pain and nausea after Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2017;13:1501–1505. - PubMed
    1. Prakash S, Saavedra R, Lehmann R, et al. . Candy cane syndrome presenting with refractory heartburn 15 years after Roux-en-Y bypass. J Surg Case Rep 2023;2023:1–3. - PMC - PubMed
    1. Almayouf M, Billa S, Alqahtani A. Candy cane syndrome at jejunojejunostomy causing small bowel obstruction following revisional laparoscopic gastric bypass: A case report and review of literature. Int J Surg Case Rep 2021;86:106360. - PMC - PubMed

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