A Case series of candy cane limb syndrome after laparoscopic Roux-en-Y gastric bypass

Khan, Khuram; Rodríguez, R. Diz; Saeed, Saqib; Persaud, Amrita; Ahmed, Leaque

doi:10.1093/jscr/rjy244

Cited by 11 publications

(16 citation statements)

References 4 publications

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“…There is an abundance of data in the literature explaining the candy cane syndrome occurring at the gastrojejunostomy ( Table 1 ). Usually, patients present with abdominal pain, which is the chief complaint [14] , [15] . Other symptoms include nausea, vomiting, gastroesophageal reflux, or weight regain, presenting chronically and affecting patients' quality of life [16] , [17] .…”

Section: Discussionmentioning

confidence: 99%

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

Almayouf

Billa²,

Alqahtani

2021

International Journal of Surgery Case Reports

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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.

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Section: Discussionmentioning

confidence: 99%

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

Almayouf

Billa²,

Alqahtani

2021

International Journal of Surgery Case Reports

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“…The pathophysiology of CCS appears to be predominantly mechanical, due to an excessively long or mispositioned blind loop proximal to the anastomosis, which promotes food passage into this loop, increasing pressure, and causing dilatation of this segment, leading to the characteristic symptoms of the syndrome: fullness, pain, reflux, regurgitation, postprandial vomiting and, eventually, food intolerance and cachexia. [1][2][3][4][5][6][7][8] This condition, first referred to as "candy cane syndrome" in 2007, appears to be an underappreciated surgical complication, but it has been increasingly reported, likely due to the increase in gastric bypass surgery for obesity. [1,3,4,8] Some case reports and small series of CCS treatment by surgical resection of the dilated loop achieved good results, but also emphasised the technical complexity of revisional surgery due to adhesions, which limits the possibility of surgical treatment in fragile patients.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] This condition, first referred to as "candy cane syndrome" in 2007, appears to be an underappreciated surgical complication, but it has been increasingly reported, likely due to the increase in gastric bypass surgery for obesity. [1,3,4,8] Some case reports and small series of CCS treatment by surgical resection of the dilated loop achieved good results, but also emphasised the technical complexity of revisional surgery due to adhesions, which limits the possibility of surgical treatment in fragile patients. [1][2][3][4] Anecdotal cases of CCS treatment with a lumen-apposing stent (n=1) or suturing devices (n=2) have been reported and we recently reported the medium-term results of a pilot series using active magnets for afferent loop marsupialization.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…[1,3,4,8] Some case reports and small series of CCS treatment by surgical resection of the dilated loop achieved good results, but also emphasised the technical complexity of revisional surgery due to adhesions, which limits the possibility of surgical treatment in fragile patients. [1][2][3][4] Anecdotal cases of CCS treatment with a lumen-apposing stent (n=1) or suturing devices (n=2) have been reported and we recently reported the medium-term results of a pilot series using active magnets for afferent loop marsupialization. [6][7][8][9] We report here the 3-year results of the first patient with CCS treated by magnet assisted endoscopic septotomy.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Endoscopic marsupialization for severe candy cane syndrome: long-term follow-up

et al. 2022

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Candy cane syndrome (CCS) is a clinical condition that may occur after gastrectomy or gastric bypass, when an excessively long or mispositioned blind jejunal loop proximal to the anastomosis is left in place. Preferential food passage in this loop results in symptoms such as fullness, pain, reflux, regurgitation, and postprandial vomiting. Surgical resection of the dilated loop is technically complex, and morbidity limits its use in fragile patients. An endoscopic approach, using dedicated active magnets, has recently been shown to be effective in the medium-term. We present here the case of a 71-year-old female patient who underwent endoscopic treatment for the first time. She presented with intractable vomiting, food intolerance, and cachexia due to CCS after total gastrectomy for gastric cancer. Surgical treatment was not an option in such a high-risk patient, and she accepted treatment with a novel endoscopic approach using a double-magnet device followed by septotomy to marsupialize the blind loop. Her symptoms were completely resolved, and she regained weight. We report here her clinical outcomes at 3 years, suggesting that endoscopic marsupialization for CCS is not only effective in the short term but also provides long-term clinical benefit.

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“…Herniation of a Roux-en-Y gastro- or esophagojejunostomy can present as “candy cane” syndrome, named for the radiographic appearance of the dilated afferent Roux limb. Risk factors include excessive length of the blind limb, 1 which may preferentially collect food as the path of least resistance. Presentation ranges from nonspecific abdominal discomfort to acute pain with nausea and vomiting.…”

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confidence: 99%