Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Feb 6;2023(2):rjad035.
doi: 10.1093/jscr/rjad035. eCollection 2023 Feb.

Valentino's syndrome: a bizarre clinical presentation

Dennis Machaku  1   2 , Mujaheed Suleman  1   2 , Elias Mduma  1   2 , Mugisha Nkoronko  1
Affiliations
Case Reports

Valentino's syndrome: a bizarre clinical presentation

Dennis Machaku et al. J Surg Case Rep. .

Abstract

A perforated peptic or duodenal ulcer may cause an unusual expression of right lower quadrant pain. In Valentino's syndrome, the chemical fluid from the ulcer flows via the right paracolic gutter to the right iliac fossa, causing peritoneal irritation and chemical appendicitis which will mimic pain in the right lower quadrant. We report a case of a 23-year-old male patient who presented with cramping lower abdominal pain with fevers and vomiting. His pain was mostly in the right lower quadrant and radiated to his back. A perforation-related pneumoperitoneum was found on a computed tomography scan, along with an accumulation of fluid in the abdomen and thickening of the pyloric antrum. Valentino's syndrome's aberrant clinical picture mimicking acute appendicitis is a pathognomonic presentation of the disease. Right lower abdominal pain should also prompt the scrutiny of atypical differentials, such as perforated ulcers. Physicians need to manage these patients with a high index of suspicion.

PubMed Disclaimer

Figures

Figure 1
Figure 1
CT scan images pointing out presence of pneumoperitoneum related to a perforation (A), with free fluid collection in the abdomen (B).
Figure 2
Figure 2
Intraoperative findings of a pinpoint perforation at the anterior aspect of the pyloric antrum (A); a consequent appendectomy was done, with the imaging (B) showing the removed appendix.
See this image and copyright information in PMC

References

    1. Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. . Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg 2020;15:1–42. - PMC - PubMed
    1. Lopez-Casillas N, Ce L-G, La L-R, Vargas-Flores E. An unusual cause of abdominal pain: Valentino’s syndrome. A case report. JPN J Gastroenterol Hepatol 2020;V4:1–3.
    1. Noussios G, Galanis N, Konstantinidis S, Mirelis C, Chatzis I, Katsourakis A. Valentino’s syndrome (with retroperitoneal ulcer perforation): a rare clinico-anatomical entity. Am J Case Rep 2020;21:1–4. - PMC - PubMed
    1. Mbarushimana S, Morris-Stiff G, Thomas G. Atypical presentation of perforated peptic ulcer disease in a 12-year-old boy. BMJ Case Rep 2014;2014:bcr2014204716. - PMC - PubMed
    1. Cherry BH, Patel D, Ronaghan JE. A case of valentino’s syndrome presenting as possible appendicitis. Int Surg 2019;104:540–1.

Publication types