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

Abstract

Introduction and Importance: Candy Cane Syndrome (CCS) is a rare condition in which the proximal gastro-jejunal attachment’s afferent blind limb is elongated. This can lead to different symptoms including nausea and vomiting, with less common 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 post-operative follow-up. Clinical Discussion: CCS is considered a rare 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.