title: ["Candy cane" Roux syndrome in laparoscopic gastric by-pass].
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Departamento de Cirugía General, Hospital General de Tijuana, Baja California, Mexico. romerocirugia@hotmail.com
authors.forename: César
authors.initials: C
authors.lastname: Romero-Mejía
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Camacho-Aguilera
authors.forename: Omar
authors.initials: O
authors.lastname: Paipilla-Monroy
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D001466:Barium Sulfate; D002432:Cecum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004108:Dilatation, Pathologic / Q000473:pathology / Q000601:surgery; D005260:Female; D015390:Gastric Bypass; D005772:Gastrointestinal Transit; D006801:Humans; D007583:Jejunum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D009325:Nausea / Q000209:etiology; D010146:Pain / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D016683:Supine Position; D017792:Surgical Stapling; D013536:Suture Techniques; D013577:Syndrome
chemical_list: D001466:Barium Sulfate