König's Syndrome After Roux-en-Y Gastric Bypass: Candy Cane Twist

BACKGROUND

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.

CASE REPORT

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 36 kg/m² (weight 100 kg, height 168 cm). At the 5-year follow-up, the patient's BMI was 22.3 kg/m² with a weight loss of 40 kg. In the last month, the patient has undergone a further weight loss of 8 kg (BMI 18.4 kg/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.

RESULTS

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.

CONCLUSION

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.

High conductivity of ultrathin nanoribbons of SrRuO3 on SrTiO3 probed by infrared spectroscopy

SrRuO3 (SRO) is a perovskite increasingly used in oxide-based electronics both for its intrinsic metallicity, which remains unaltered in thin films and for the ease of deposition on dielectric perovskites like SrTiO3, (STO) to implement SRO/STO microcapacitors and other devices. In order to test the reliability of SRO/STO also as high-current on-chip conductor, when the SRO dimensions are pushed to the nanoscale, here we have measured the electrodynamic properties of arrays of nanoribbons, fabricated by lithography starting from an ultrathin film of SRO deposited on a STO substrate. The nanoribbons are 6 or 4 nm thick, 400, 200 and 100 nm wide and 5 mm long. The measurements have been performed by infrared spectroscopy, a non-contact weakly perturbing technique which also allows one to separately determine the carrier density and their scattering rate or mobility. Far-infrared reflectivity spectra have been analyzed by Rigorous Coupled-Wave Analysis (RCWA) and by an Effective Medium Theory, obtaining consistent results. With the radiation polarized along the nanoribbons, we obtain a carrier density similar to that of a flat film used as reference, which in turn is similar to that of bulk SRO. Moreover, in the nanoribbons the carrier scattering rate is even smaller than in the unpatterned film by about a factor of 2. This shows that the transport properties of SRO deposited on STO remain at least unaltered down to nanometric dimensions, with interesting perspectives for implementing on-chip nano-interconnects in an oxide-based electronics. When excited in the perpendicular direction, the nanoribbons appear instead virtually transparent to the radiation field, as predicted by RCWA.