“Candy Cane” Syndrome: a Rare Complication After Roux-en-Y Gastric Bypass — Case Report

“Candy Cane” syndrome is a rare and underreported complication after Roux-en-Y gastric bypass (RYGB). It refers to an excessive length of the blind jejunal limb at the gastro-jejunostomy in reference to the so-called cane shaped candy. Patients usually present with non-specific symptoms such as abdominal pain associated with nausea, vomiting or regurgitation, as well as insufficient weight loss or weight regain. More than one diagnostic tool is required when investigating symptomatic patients. Surgical resection of this redundant segment is associated with resolution of symptoms in the majority of patients. This case report intends to alert surgeons to this complication, briefly review the existing literature on the subject, and illustrate the intraoperative findings in video format. A 43-year-old female, with history of laparoscopic Sleeve gastrectomy for obesity and surgical revision to RYGB for gastric stricture presents 3 months after surgery with postprandial epigastric pain, nausea, and vomiting. Gastro-intestinal tract fluoroscopy showed an excessively long blind jejunal limb next to the gastro-jejunostomy. “Candy Cane” syndrome was assumed as the cause of symptoms. Laparoscopic resection of excessive blind limb was performed with improvement from initial complaints. After reviewing the video from the RYGB it was confirmed that the blind jejunal limb left was too long. Intraoperatively, the preferential filling of this loop, characteristic of this syndrome, was observed. Surgical resection of the redundant segment improved clinical symptoms, as described for the majority of patients. Assuring a short blind jejunal limb at the gastro-jejunostomy in primary RYGB can prevent “Candy Cane” syndrome.