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.
A 36-year-old morbidly obese female with BMI 66 kg/m2, scheduled for elective laparoscopic sleeve gastrectomy. Prior to the surgery patient had symptoms of mild dyspnea, vague abdominal discomfort. CAT scan of thorax and abdomen revealed a right-sided large morgagni diaphragmatic hernia containing omentum and portion of the transverse colon. Patient elected to undergo Laparoscopic sleeve gastrectomy and concomitant morgagni diaphragmatic hernia repair. The post-operative course was uneventful and the patient was discharged on post-operative Day 2.
This case is an extremely rare case of super obese patient with Morgagni hernia who desires bariatric surgery and found to have incidental finding of morgagni hernia. This kind of combination can safely undergo concomitant laparoscopic hernia repair with mesh and sleeve gastrectomy.
Extrahepatic portal hypertension is not an uncommon disease in childhood, but isolated inferior mesenteric portal varices and lower gastrointestinal (GI) bleed have not been reported till date. A 4-year-old girl presented with lower GI bleed. Surgical exploration revealed extrahepatic portal vein obstruction with giant inferior mesenteric vein and colonic varices. Inferior mesenteric vein was joining the superior mesenteric vein. The child was treated successfully with inferior mesenteric – inferior vena caval anastomosis. The child was relieved of GI bleed during the follow-up.
Concomitant surgery is an attractive option because of convenience. To our knowledge, this is the first study reporting concomitant laparoscopic sleeve gastrectomy (LSG) and laparoscopic right adrenalectomy. A retrospective review of three patients with obesity and a unilateral adrenal mass was conducted. The demographics, workup, surgical technique and outcome were presented. Patient 1 had a body mass index (BMI) of 41 kg/m2, diabetes mellitus (DM), hypertension (HTN) and a right adrenal pheochromocytoma. Patient 2 had a BMI of 40 kg/m2, insulin-dependent DM, uncontrolled HTN, chronic kidney disease, ischemic heart disease and an aldosterone secreting right adrenal adenoma. Patient 3 had a BMI of 41 kg/m2, dyslipidemia, HTN and gout. All patients underwent concomitant LSG and laparoscopic adrenalectomy (LA). LSG and LA is a feasible and safe concomitant surgery when performed under specific measures with minimal morbidity and more convenience.
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