Suspected Valentino’s Syndrome mimicking acute appendicitis: a case report and literature review

Valentino’s Syndrome is a rare affliction caused by the perforation of a peptic ulcer which simulates deviously a picture of acute appendicitis. The diagnosis of this condition is not simple (often intraoperative) and requires a high degree of suspicion. A 90-year-old man arrived at the Emergency Room with abdominal pain mainly localized in the right iliac fossa (Blumberg +, McBurney +). The patient had a history of previous perforated peptic ulcer treated with surgery. A diagnosis of suspected perforated acute appendicitis was made based on clinical and radiological findings and the patient underwent urgent surgical intervention. Laparoscopic exploration revealed a picture of diffuse choleperitonitis due to a probable perforation of a duodenal ulcer. Considering the patient's age and the severity of the clinical and surgical picture, characterized by the presence of indissociable intra-abdominal adhesions, it was decided to forgo further surgical procedures, except drainage of the abdominal cavity and palliative medical treatment, due to a poor prognosis.This syndrome, although very rare, should always be suspected in cases of right iliac fossa pain in the presence of certain risk factors for perforated peptic ulcer.