Abstract
A König's syndrome is referred to abdominal pain in relation to meals with constipation alternated with diarrhea, meteorism, and abdominal distension. A postoperative long-term complication after Roux-en-Y gastric bypass could be the appearance of chronic abdominal pain associated with vomiting, dysphagia, and nausea. A 43-year-old female patient was submitted for a Roux-en-Y gastric bypass for morbid obesity with an initial body mass index (BMI) of 36kg/m2 (weight 100kg, height 168cm). At the 5-year follow-up, the patient's BMI was 22.3kg/m2 with a weight loss of 40kg. In the last month, the patient has undergone a further weight loss of 8kg (BMI 18.4kg/m2) with the presence of chronic abdominal pain, dyspepsia, and dysphagia and abdominal distension. Any vasomotor problems (hot flushing, sweating, palpitations, and diarrhea) were described. The computer tomography (CT) with oral contrast shows the presence of a blind afferent Roux limb at the gastrojejunostomy, explaining a possible König's syndrome. The patient was submitted for a diagnostic laparoscopy, which revealed the presence of a twisted candy cane that was identified and resected. The postoperative stages were uneventful and the patient was discharged on the second postoperative day. Candy cane syndrome is a rare and challenging complication reported in bariatric patients following Roux-en-Y gastric bypass and is best investigated with a barium swallow or oesophago-gastro-duodenoscopy (OGD). This means that this kind of pathology could be avoided by not leaving such a long blind loop during the primary gastric bypass operation. An explorative laparoscopy could be performed in the event of abdominal pain, nausea, and vomiting at a long-term follow-up after gastric bypass. Even if there are little data regarding the efficacy of surgical treatment, if present, "candy cane" surgical revision seems to be the best treatment for the majority of the patients with long-term symptomatic relief.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
