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

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.

Fishbone perforating Meckel’s diverticulum: an acute appendicitis mimicker

“…A condition called Valentino’s syndrome has been described in the literature, where perforation of the peptic ulcer leads to leakage of the digestive fluid, which seeps and settles down in the right iliac fossa, causing inflammation and leading to signs and symptoms of acute appendicitis [ 12 ]. Although Valentino’s syndrome has not been described in relation to the perforation of Meckel’s diverticulum, it can lead to leakage of the digestive fluid, which might cause appendicular inflammation in a similar fashion.…”

Valentino’s syndrome: a bizarre clinical presentation

“…[ 9 ]. A proposed CT scan may reveal the presence of free fluid with exudates, with features suggestive of a perforation [ 10 , 11 ]. The role of laparoscopic surgery should be enunciated in cases of diagnostic dilemma.…”

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

“…The differentials for this symptom are vast and challenging, which can be surgical or medical. Among the surgical causes, appendicitis is the most common one 1 while other causes are colitis, ovarian torsion, ruptured ectopic, Crohn disease, lymphadenitis, diverticulitis, etc 2,3 . One rare differential is Valentino syndrome—duodenal perforation presenting as right iliac fossa pain mimicking appendicitis.…”