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Candy cane syndrome presenting with refractory heartburn 15 years after Roux-en-Y bypass
Shahana Prakash1,2, Ramses Saavedra3, Ryan Lehmann3
1Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Journal of Surgical Case Reports
|March 21, 2023
Summary
Candy cane syndrome (CCS), a rare Roux-en-Y gastric bypass complication, can present with heartburn years later. Early diagnosis and surgical correction of the long afferent limb are crucial for symptom resolution.
Area of Science:
- Gastroenterology
- Bariatric Surgery
Background:
- Roux-en-Y gastric bypass (RYGB) is a common bariatric procedure.
- Candy cane syndrome (CCS) is a rare complication characterized by an excessively long afferent jejunal limb.
- Typical CCS symptoms include abdominal pain, nausea, and vomiting.
Observation:
- A 57-year-old female presented with 7 months of refractory heartburn post-RYGB.
- Upper endoscopy identified a 9 cm blind afferent jejunal limb, indicative of CCS.
- This case represents the longest reported duration (15 years) from RYGB to CCS symptom onset.
Findings:
- Heartburn is an uncommon presenting symptom for CCS.
- Surgical resection of the elongated afferent limb successfully resolved the patient's symptoms.
Implications:
- Clinicians should consider CCS in RYGB patients with refractory heartburn, irrespective of the time since surgery.
- Maintaining a high index of suspicion for CCS is vital for timely diagnosis and effective management.
- This case expands the known clinical presentation and timeline of CCS.
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