S6378 From Virtual to Procedural: A Case of Candy Cane Syndrome Diagnosed Through Hybrid GI Care

Introduction: Candy Cane Syndrome is a rare postoperative complication following Roux-en-Y gastric bypass in which there is an excessively long blind afferent Roux limb (“candy cane”) at the gastrojejunostomy. This acts as an obstructed loop when filled with food, and distention of the loop causes abdominal pain until the food either passes into the Roux limb or is vomited. Diagnosis is often delayed due to nonspecific symptoms and limited awareness. Case Description/Methods: A 53-year-old woman with a past medical history of refractory peptic ulcer disease of the antrum and duodenum status-post Roux-en-Y reconstruction in November 2020 presented to our virtual multidisciplinary clinic for evaluation of a 1-year history of persistent nausea, vomiting, and abdominal burning. Lab results revealed a normal white blood cell count, lipase, C-reactive protein, and normocytic anemia (hemoglobin 10.4 g/dl, mean corpuscular volume 87 fl). A computed tomography (CT) scan of abdomen and pelvis and ultrasound were unremarkable. A H. pylori stool antigen was negative. She was placed on omeprazole 40 mg twice per day and sucralfate 1 g tablet 3 times per day due to prior peptic ulcer disease. She was evaluated by a GI-focused registered dietician and behavioral health provider and implemented their management recommendations. The patient continued to experience nausea, vomiting, and abdominal discomfort despite the treatment plan, therefore, endoscopic evaluation was scheduled with a local partner gastroenterologist. The upper endoscopy revealed a large food bezoar in the stomach with evidence of prior surgery described as a long blind loop, concerning for Candy Cane Syndrome. The patient was then referred back to her surgeon for revision. Discussion: This case illustrates diagnostic challenges of Candy Cane Syndrome, particularly when conventional imaging fails to reveal the underlying pathology. It underscores the importance of clinical acumen in evaluating post-Roux-en-Y gastric bypass patients with persistent symptoms. Importantly, this case demonstrates how hybrid care models—integrating virtual multidisciplinary care with selective in-person procedural escalation— can enable accurate, timely diagnosis and comprehensive management of complex postoperative conditions. Virtual multidisciplinary models can enhance access to expert evaluation, coordinate diagnostic strategies, and support earlier recognition of complications like Candy Cane Syndrome, ultimately improving outcomes in complex gastrointestinal presentations.