A Case of Valentino's Syndrome Presenting as Possible Appendicitis

Background: One of the most common causes of right lower quadrant abdominal pain is acute appendicitis. The most frequent symptoms observed are periumbilical pain that radiates to the right lower quadrant, anorexia, nausea and vomiting. Other conditions which mimic acute appendicitis at presentation include ovarian torsion, ruptured ectopic pregnancy, pseudomembranous colitis, and perforated cholecystitis. Here, we present a unique case of Valentino’s syndrome, wherein a perforated duodenal ulcer manifested the same constellation of symptoms as acute appendicitis. Case Information: When computed tomography and ultrasound were not definitive for the diagnosis, the decision was made to perform a laparoscopic appendectomy. The appendix showed no gross signs of inflammation, so intraoperative esophagogastroduodenoscopy was used to examine for a perforated peptic ulcer. When no perforations were found, exploratory laparotomy was performed and revealed purulent fluid in the right colic gutter and a pinhole perforation in the first part of the duodenum. The defect was repaired and the abdominal space was washed thoroughly and closed. The patient recovered well and was discharged from the hospital in good health. Conclusion: Valentino’s syndrome is an uncommon cause of RLQ pain and symptoms mimicking acute appendicitis.