Slovenská chirurgia 4/2022

Valentino syndrome – atypical presentation perforated gastroduodenal ulcer

Pain in the left or right lower quadrant of the abdomen is a common complaint of patients in the emergency department, but relatively few cases of Valentino syndrome have been described. An incorrect diagnosis can lead to disastrous consequences. The case report presents a 35-year-old patient with a history of worsening abdominal pain in the right lower quadrant. Laboratory results indicated a leukocytosis just above normal values. Abdominal X-ray showed no signs of perforation of the gastrointestinal tract. Due to signs of diffuse peritoneal irritation with maximum sensitivity in the right lower abdomen, appendectomy was indicated without additional imaging methods. Minimal perioperative inflammatory changes in the appendix led to a revision of the abdominal cavity with the finding of a perforated juxtapyloric ulcer with the performance of a primary suture and omentoplasty. Fear of delaying treatment by performing imaging tests can lead to a misdiagnosis. Opioid analgesia can be used before a definitive diagnosis is made and does not lead to misdiagnosis. The presence of periappendicitis during surgery obliges the surgeon to rule out other pathologies and prevent catastrophic consequences. The preferred methods of surgical treatment include primary suture or omentoplasty of the perforated ulcer, with conservative management possible in strict indications.

Keywords: Valentino syndrome, appendicitis mimics, peptic ulcer, case report