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Intussusception, a Plausible Cause of the Candy Cane Syndrome (Roux Syndrome): Known for a Century—Still a Frequently Missed Cause of Pain After Roux-en-Y Gastric Bypass

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Abstract

Background

Candy cane syndrome (CCS), which is also called Roux syndrome, is a rarely reported and neglected complication of proximal Roux-en-Y gastric bypass (RYGB) surgery.

Methods

Forty-seven cases of CCS that underwent candy cane (CC) resection were analyzed retrospectively for pain remission to determine whether intussusception is a possible underlying mechanism.

Results

Forty-three patients (89.6%) benefited from laparoscopic CC resection (p < 0.001). The highly sensitive diagnostic tests were upper gastrointestinal series (91%) and gastroscopy (96%). Intussusception of the CC into the gastric pouch was demonstrated in most cases and was postulated as the trigger for CCS. In some cases, retroperistaltic intussusception led to nonspecific upper gastrointestinal bleeding.

Conclusion

A vast majority of CCS cases benefited significantly from CC resection. The long-described retroperistaltic intussusception of the CC was suggested as an important underlying mechanism of the symptoms. Although CC resection remains a stopgap, evidence on its clinical significance has been shown for a century. Building on this wealth of experience and the already vast storage of practical knowledge, awareness of this underestimated complication after RYGB should be raised.

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Abbreviations

RYGB:

Proximal Roux-en-Y gastric bypass

CC:

Candy cane

CCS:

Candy cane syndrome

SBO:

Small bowel obstruction

UGI:

Upper gastrointestinal series

CT:

Computed tomography

IFSO:

International Federation for the Surgery of Obesity and Metabolic Disorders

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Statement of Author Contribution

All authors performed substantial contributions to conception and design of the article and to acquisition, analysis, and interpretation of data. All authors reviewed the manuscript for important intellectual content and approved the final version for publication. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Authors and Affiliations

  1. Obesity Center NRW- Adipositaszentrum NRW, Sana Kliniken, Krankenhausstraße 42, 50354, Hürth, Germany

    Christine Stier

  2. Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach, Germany

    Christine Stier & Norbert Runkel

  3. Obesity Center, University Hospital Wuerzburg, Wuerzburg, Germany

    Ann-Kathrin Koschker

  4. Department of General Surgery, Helios Klinik Erfurt, Erfurt, Germany

    Yaroslaw Isaev

  5. Department of Obesity and Metabolic Surgery, Ospedale Evangelico Betania, Naples, Italy

    Sonja Chiappetta

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  1. Christine Stier
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Correspondence to Christine Stier.

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Work was performed at Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach am Main, Germany and Obesity Center, University Hospital Wuerzburg, Wuerzburg, Germany.

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Stier, C., Koschker, AK., Isaev, Y. et al. Intussusception, a Plausible Cause of the Candy Cane Syndrome (Roux Syndrome): Known for a Century—Still a Frequently Missed Cause of Pain After Roux-en-Y Gastric Bypass. OBES SURG 30, 1753–1760 (2020). https://doi.org/10.1007/s11695-020-04398-3

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