Acute abdomen and pneumoperitoneum: complications after gastric bypass in Candy Cane syndrome

The Roux-en-Y gastric bypass surgery has been largely spread to solve obesity issues, especially because of its positive cost-benefit in the long run and its effect on metabolic disorders, such as type 2 diabetes mellitus. Although, there are some complications, being one of them the Candy Cane syndrome (CC), a complication that can come from the dilatation of the excedent portion of the gastroenteric anastomosis on the alimentary limb after Roux-en-Y gastric bypass surgery. This syndrome is mainly a consequence of improper surgical technique. In this syndrome the patient experiences unspecific symptoms, such as abdominal pain, nausea and emesis. We report this case where there is a rupture of this portion. causing severe acute abdomen and voluminous pneumoperitoneum. Even though the main bypass surgery complications are stenosis and dehiscences, the reported case shows how important it is to properly manage bypass patients' complaints, even if it is vague or chronic, in order to keep on track of the possibility of anastomosis expansion, such as in CC. Our aim was to show a possible complication - with considerable risk to the patient - in order to give to the medical community one more diagnosis hypothesis and to alert the importance of appropriate Rouxen-Y gastric bypass surgical technique.