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

Abstract

Background Candy cane syndrome (CCS) is a rare and underreported complication, seldom occurring after bariatric surgeries, especially, the Roux-en-Y gastric bypass (RYGB) type. It refers to an excessively long-blind end of the alimentary limb, usually at the gastrojejunal (GJ) junction, and to a lesser extent, can occur at the jejunojejunal (JJ) junction, that may cause symptoms including abdominal pain, regurgitation, nausea, vomiting and reflux. However, its diagnosis can be challenging and misleading. Case Description A 34-year-old woman with a multiple past surgical history presented with small bowel obstruction (SBO) symptoms following a second gastric bypass surgery. An esophagogastroduodenoscopy (EGD) was inconclusive, then a computed tomography (CT) scan was done, which reported intussusception. The patient underwent laparoscopy, which revealed an anastomosis with an extra 14 cm of single-loop bowel near the JJ junction rather than intussusception, leading to a diagnostic laparoscopy followed by a mini-laparotomy procedure. Adhesiolysis followed by a resection of the elongated blind end was done, hence, the diagnosis of CCS was established. The patient tolerated the surgery with a complete resolution of her symptoms; no subsequent complications were reported. Conclusions The frequency of RYGB surgery and the number of past surgeries a patient might have undergone might correlate independently with the risk of developing CCS.