Candy cane syndrome at jejunojejunostomy causing small bowel obstruction following revisional laparoscopic gastric bypass: A case report and review of literature

Abstract

Introduction and importance The literature described Candy cane syndrome (CCS) as causing various symptoms and affecting patients' quality of life. Most of the literature described this syndrome occurrence at gastrojejunostomy (GJ) anastomosis. The literature lacks data on this syndrome occurring at the jejunojejunostomy (JJ). Case presentation We describe a patient who underwent revision of laparoscopic gastric bypass (LGB) due to weight regain and presented three days after the procedure with small bowel obstruction (SBO). The patient was admitted as she demonstrated a picture of SBO. A complete workup and contrast study was done and showed dilated bowel loops. The patient was taken for exploratory laparoscopy, which revealed dilated 10–15 cm candy cane near the JJ, causing and obstruction. Resection of the elongated blind pouch was done, and the patient tolerated the surgery with improvement in her symptoms. Preoperative imaging, perioperative management, procedure videos, and follow-up were used to describe the case. Clinical discussion After reviewing the literature, eight papers reported CCS, 7 of those articles mentioned the syndrome located at the GJ. CCS located near the JJ can lead to symptoms including SBO. Management is mainly surgical, and prevention of occurrence can be achieved by limiting unnecessary elongated blind pouches. Conclusion CCS is a well-established condition occurring at the GJ following LGB, but it can manifest similarly if an elongated blind limb is left unresected at the JJ.

Mini laparotomy for candy cane syndrome at the jejunojejunostomy after a second Roux Y Gastric bypass with multiple surgical history: a case report

“…As illustrated in the under-reported CCS cases worldwide, patients usually present non-specific GI symptoms ( 6 ) along with a typical location; the GJ junction ( 4 ). This case is different as obstruction took place at an unusual location; the JJ junction.…”

“…Although CCS is a well-described entity after laparoscopic-gastric bypass (LGB), often occurring near the gastrojejunal (GJ) junction and causing vague symptoms, it can manifest near the jejunojejunal (JJ) junction, leading to a more severe and acute presentation such as SBO ( 4 ).…”

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

“…Management is mainly surgical by resection of the dilated loop but it is technically complex due to adhesions or distorted anatomy that might increase the complications. The laparoscopic approaches can be feasible and safe to improve patient’s recovery 1 – 5 . In this manuscript, we describe the case of a 38-year-old female patient who was diagnosed with CCS after Roux-en-Y surgery, focusing on clinical signs, treatments, and contributing valuable insights into this rare post-bariatric complication.…”