["Candy cane" Roux syndrome in laparoscopic gastric by-pass]

With the worldwide epidemic of obesity, there has been an increase in the numbers of procedures of bariatric surgery such as the Roux-en-Y gastric bypass. Nevertheless, this type of surgery is not exempt from complications such as those described as "candy cane" Roux syndrome.

We present the case of a 34-year-old female with previous diagnosis of morbid obesity (BMI 38.5 kg/m(2)) who underwent laparoscopic Roux-en-Y gastric bypass 2 years previously. Six months ago the patient presented intermittent epigastric pain of moderate intensity radiating towards the left hypochondrium. The patient reported no limitations of activities of daily living. Pain was associated with ingestion of carbonated beverages and ventral decubitus position. Upper gastrointestinal (GI) series was done, observing a blind, dilated jejunal loop adjacent to the gastrojejunal anastomosis. Suspicion of "candy cane" Roux syndrome was established. Exploratory laparoscopy and resection of the blind jejunal loop with stapler was done. Nine months later the patient is asymptomatic.

Symptoms of these patients are nonspecific, and a high level of suspicion is required. The best study to evaluate this clinical entity is the upper GI series. The recommendation for bariatric surgeons is to minimize the length of the blind loop in the gastrojejunal anastomosis and to place it towards the right side to favor its drainage by gravity and eliminate problems in the jejuno-jejuno anastomosis that cause a retrograde expansion of the Roux-en-Y limb. Therefore, laparoscopic resection is the best method for the treatment of this syndrome.