A Cautionary Tale: Unveiling Valentino’s Syndrome

Abstract

Introduction: In the emergency room, acute pain in the abdomen is one of the most common symptoms that patients present with, and it is a result of a myriad of causes, leading to an exhaustive differential diagnosis. A perforated peptic ulcer is a rare cause of acute right iliac fossa or lower quadrant abdominal pain. It causes leakage of gastrointestinal contents in the area, resulting in localized inflammation and pain that is clinically similar to acute appendicitis. This condition is known as Valentino's syndrome.Aim: This study aims to highlight clinical and radiological features for patients with Valentino's syndrome, improving diagnostic accuracy.Methods: The authors conducted a retrospective analysis of all diagnosed cases of Valentino's syndrome from multiple facilities within the same organization for the research study. A total of 14 nonsequential cases were gathered. The term "Valentino's syndrome" was used to search in the PubMed and Google Scholar databases for the review of literature, and only 17 cases were found and reviewed.Results: Of the 31 patients, 83.9% were male, with a mean age of 39 years. Of all patients who presented with abdominal pain, 25.8% had it in the lower right abdomen. Vomiting (38.7%), nausea (35.4%), fever (16.1%), and constipation were all associated symptoms (12.9%). All cases were clinically diagnosed as acute appendicitis. Many patients had elevated levels of white blood cells, neutrophils, and CRP. Computed tomography (CT) scan was used in 70.9% of the cases, followed by ultrasound (58%) and x-ray (45.1%), where pneumoperitoneum and duodenal perforations were common. Graham's patch was used in 48.3% of the cases, appendectomy was used in 16.1% of the cases, and conservative care was used in 19.3% of the cases. Most patients were given proton pump inhibitors and antibiotics for Helicobacter pylori.Conclusion: Timely diagnosis of Valentino's syndrome via CT imaging is critical because it leads to immediate perforation repair. Patients' mortality and morbidity may be reduced if they are aware of the condition and receive an accurate, rapid preoperative diagnosis.

Valentino’s syndrome: a bizarre clinical presentation

“…Fluid leaking from a perforated gastric or duodenal ulcer may induce peritonitis if it drains down the right paracolic gutter. It may spread to the appendix, causing chemical irritation that mimics acute appendicitis and culminating in Valentino’s syndrome [ 6 ]. The presence of pneumoperitoneum is often formed by the intraperitoneal perforation of the stomach or first part of the duodenum, whereas pneumo-retroperitoneum (typical in the right kidney, ‘veiled right kidney sign’) is caused by a retroperitoneal perforation [ 7 ].…”

Valentino's Syndrome—A Rare Complication of Pancreatic Stent Migration

“…2 Performing a CECT abdomen or a diagnostic laparoscopy in cases with doubtful appendicitis will help in picking up this condition and avoids unnecessary appendectomy and re-explorations. 6…”

“…Early diagnosis is important as delay in diagnosis can lead to mortality and morbidity 2 . Performing a CECT abdomen or a diagnostic laparoscopy in cases with doubtful appendicitis will help in picking up this condition and avoids unnecessary appendectomy andre-explorations 6 …”

“…The management described for Valentino syndrome is mostly surgical repair of the perforation along with lavage. 6 Surgeons must keep in mind this differential when a patient presents with appendicitis and intraoperatively the appendix is normal. Early diagnosis is important as delay in diagnosis can lead to mortality and morbidity.…”

Valentino’s syndrome: A rare and lethal differential diagnosis for acute appendicitis

“…A combination of Alvarado score, elevated CRP level, and positive ultrasonographic findings has shown a higher diagnostic accuracy limiting the use of CECT of the abdomen (sensitivity of 94% and specificity of 95%) for equivocal cases. 13 – 15 As the initial diagnosis of acute appendicitis was based on the above three criteria, CECT of the abdomen was not performed prior to surgery in this case.…”