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Machaku D, Suleman M, Mduma E, Nkoronko M. Valentino's syndrome: a bizarre clinical presentation. J Surg Case Rep 2023; 2023:rjad035. [PMID: 36755937 PMCID: PMC9902202 DOI: 10.1093/jscr/rjad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/17/2023] [Indexed: 02/09/2023] Open
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.
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Affiliation(s)
| | - Mujaheed Suleman
- General Surgery, Kilimanjaro Christian Medical Center, Kilimanjaro, Tanzania,Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - Elias Mduma
- General Surgery, Kilimanjaro Christian Medical Center, Kilimanjaro, Tanzania,Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - Mugisha Nkoronko
- General Surgery, Kilimanjaro Christian Medical Center, Kilimanjaro, Tanzania
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Gutierrez-Alvarez M, Vallarta S, Cruz R, Visag-Castillo V. An Unusual Presentation of Valentino Syndrome With a Perforated Gastric Ulcer as a Cause of Abdominal Pain: A Case Report. Cureus 2023; 15:e34845. [PMID: 36919060 PMCID: PMC10008320 DOI: 10.7759/cureus.34845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/12/2023] Open
Abstract
Numerous pathologies can cause abdominal pain; thus, the surgeon's job is to precisely identify any pathologies that may require surgery and endanger the patient's life. Perforation of a gastric or duodenal ulcer associated with a clinical picture of acute appendicitis is known as Valentino syndrome (VS). To our knowledge, there are 22 cases of VS reported in the literature. We describe the clinical case of a 53-year-old female patient with abdominal pain in the right iliac fossa who came to the emergency room. A plain tomography was performed, which found free intraperitoneal fluid and free subdiaphragmatic air. Therefore, a laparotomy was performed, revealing a gastric perforation. VS is a rare pathology and when not recognized and managed properly, it can increase patients' mortality.
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Affiliation(s)
| | | | - Rodrigo Cruz
- Department of General Surgery, Medica Sur, Mexico, MEX.,Department of Transplants, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, MEX
| | - Victor Visag-Castillo
- Department of General Surgery, Medica Sur, Mexico, MEX.,Department of Transplants, Hospital General de Mexico, Mexico, MEX
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Rodrigo VEU, de Silva GPUP, Jayasinghe DSH, Thalagaspitiya SPB, Srishankar S, Wickramarathne D, Karunadasa MSE. Valentino's syndrome: A rare and lethal differential diagnosis for acute appendicitis. SAGE Open Med Case Rep 2022; 10:2050313X221132069. [PMID: 36324598 PMCID: PMC9618742 DOI: 10.1177/2050313x221132069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022] Open
Abstract
Due to the rarity of the condition, Valentino’s syndrome is an underrated differential diagnosis for acute appendicitis. We describe a patient with Valentino’s syndrome in whom preoperative and intraoperative diagnoses were challenging due to misleading clinical, investigative, and morphological findings. A 31-year-old woman who was on methylprednisolone for sensory radiculopathy presented to the emergency department with acute right lower quadrant pain. The clinical diagnosis of acute appendicitis was supported by the elevated inflammatory markers and ultrasonographic findings. An appendicectomy and an ovarian cystectomy were performed due to the findings of mild appendicitis and right ovarian endometrioma, respectively. Postoperatively, she developed peritonitis with a purulent bile-stained discharge from the surgical site and per vagina. Contrast-enhanced computed tomography of the abdomen showed a retroperitoneal collection at the second lumbar vertebral level extending along the right paracolic gutter to the pelvis and intraperitoneal fluid collections in right lower quadrant and pelvis. An emergency exploratory laparotomy confirmed a perforation at the posterior aspect of the duodenum which was repaired with an omental patch. Unfortunately, relaparotomy and end ileostomy were required due to colonic perforation with the eroded drain tube. She made an uneventful recovery with intensive care and underwent ileostomy reversal after 12 weeks. We emphasize the clues to have a high degree of suspicion during preoperative and intraoperative evaluation to recognize this lethal mimicker of acute appendicitis.
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Affiliation(s)
- VEU Rodrigo
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - GPUP de Silva
- Colombo South Teaching Hospital, Dehiwala-Mount Lavinia, Sri Lanka,GPUP de Silva, Colombo South Teaching Hospital, Dehiwala-Mount Lavinia, Sri Lanka.
| | - DSH Jayasinghe
- Professorial Surgical Unit, Teaching Hospital Anuradhapura, Anuradhapura, Sri Lanka
| | - SPB Thalagaspitiya
- Professorial Surgical Unit, Teaching Hospital Anuradhapura, Anuradhapura, Sri Lanka
| | - S Srishankar
- Professorial Surgical Unit, Teaching Hospital Anuradhapura, Anuradhapura, Sri Lanka
| | | | - MSE Karunadasa
- Faculty of Medicine, Wayamba University of Sri Lanka, Kuliyapitiya, Sri Lanka
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MARCEVIANTO KV, DJATMIKO YB, LORENZA A, WITYANINGSIH YS. Optimal management for a sequela of Valentino's Syndrome with intra-abdominal sepsis in a geriatric patient. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05288-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mahajan PS, Abdulmajeed H, Aljafari A, Kolleri JJ, Dawdi SA, Mohammed H. A Cautionary Tale: Unveiling Valentino’s Syndrome. Cureus 2022; 14:e22667. [PMID: 35371708 PMCID: PMC8965196 DOI: 10.7759/cureus.22667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/05/2022] Open
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Noussios G, Galanis N, Konstantinidis S, Mirelis C, Chatzis I, Katsourakis A. Valentino's Syndrome (with Retroperitoneal Ulcer Perforation): A Rare Clinico-Anatomical Entity. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922647. [PMID: 32612093 PMCID: PMC7347034 DOI: 10.12659/ajcr.922647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient: Male, 51-year-old Final Diagnosis: Valentinos syndrome • perforated duodenal ulcer to the retroperitoneum Symptoms: Epigastric pain • loss of appetite • nausea • right lower quadrant abdominal pain Medication: — Clinical Procedure: Exploratory laparotomy Specialty: Surgery
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Affiliation(s)
- George Noussios
- Department of Physical Education and Sports Sciences of Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikiforos Galanis
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Charalambos Mirelis
- Department of General Surgery, Agios Dimitrios General Hospital, Thessaloniki, Greece
| | - Iosif Chatzis
- Department of General Surgery, Agios Dimitrios General Hospital, Thessaloniki, Greece
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Munoz Abraham AS, Osei H, Martino A, Kazmi S, Saxena S, Fitzpatrick CM, Villalona GA. Incidence and Outcomes of Perforated Peptic Ulcers in Children: Analysis of the Kid's Inpatient Database and Report of Two Cases Treated by Laparoscopic Omental Patch Repair. J Laparoendosc Adv Surg Tech A 2019; 29:248-255. [DOI: 10.1089/lap.2018.0186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Armando Salim Munoz Abraham
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, Saint Louis, Missouri
| | - Hector Osei
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, Saint Louis, Missouri
| | - Alice Martino
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Sakina Kazmi
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Saurabh Saxena
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Colleen M. Fitzpatrick
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, Saint Louis, Missouri
| | - Gustavo A. Villalona
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, Saint Louis, Missouri
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Amann CJ, Austin AL, Rudinsky SL. Valentino's Syndrome: A Life-Threatening Mimic of Acute Appendicitis. Clin Pract Cases Emerg Med 2017; 1:44-46. [PMID: 29849430 PMCID: PMC5965439 DOI: 10.5811/cpcem.2016.11.32571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 11/11/2022] Open
Abstract
Perforated ulcers are a rare cause of abdominal pain, and may not be considered when pain is localized to the right lower quadrant (RLQ). This case highlights an unusual presentation of a perforated duodenal ulcer that presented with RLQ pain, which has been described as Valentino’s syndrome. Valentino’s syndrome occurs when gastric or duodenal fluids collect in the right paracolic gutter causing focal peritonitis and RLQ pain. This case highlights that perforated ulcers, while an uncommon cause of RLQ pain, must remain on the differential of any patient that has an abdominal examination consistent with peritonitis.
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Affiliation(s)
- Christopher J Amann
- Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California
| | - Andrea L Austin
- Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California
| | - Sherri L Rudinsky
- Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California
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