Valentino’s syndrome – a systematic review of a life-threatening mimic of acute appendicitis
DOI:
https://doi.org/10.15584/ejcem.2024.4.15Keywords:
appendicitis, Graham’s patch, peptic ulcer, perforation, peritonitis, Valentino’s syndromeAbstract
Introduction and aim. Valentino’s syndrome is an atypical but potentially lethal presentation of a perforated peptic ulcer. It closely mimics appendicitis. Literature about this disorder is sparse due to its rarity. Hence, this article was compiled to gain an understanding of this disorder. This article was composed to review the profiles of patients with Valentino’s syndrome reported in the recent literature.
Material and methods. A systematic literature search was conducted through electronic databases, including PubMed, ResearchGate, and Scopus, using the key words and terms “Valentino’s syndrome,” “perforated duodenal ulcer simulating acute appendicitis,” and “perforated peptic ulcer mimicking acute appendicitis.” Only English literature was considered for inclusion in this study, and the time frame was fixed between 2012 and 2023.
Analysis of the literature. Twenty-seven cases from both genders, ranging in age from 7 to 76 years, were included in the review. In 20 cases, the diagnosis was made at laparotomy for a presumed diagnosis of acute appendicitis. Six cases had undergone appendectomy as their first surgical operation, but their condition had worsened postoperatively and had undergone re-exploration at a delay of 3 to 10 days (mean 6±2.86 days; mode 3 days). One patient required a third abdominal exploration.
Conclusion. Valentino’s syndrome has a very high rate of misdiagnosis. There is a need to increase awareness of this disorder among healthcare professionals so that it might be considered a differential diagnosis while a patient is being evaluated for acute abdomen.
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References
Yeh B. Does this adult patient have appendicitis? Ann Emerg Med. 2008;52(3):301-303. doi: 10.1016/j.annemergmed.2007.10.023
Wijegoonewardene SI, Stein J, Cooke D, Tien A. Valentino’s syndrome a perforated peptic ulcer mimicking acute appendicitis. BMJ Case Rep. 2012;2012:bcr0320126015-bcr0320126015. doi: 10.1136/bcr.03.2012.6015
Mahajan PS, Abdalla MF, Purayil NK. First report of preoperative imaging diagnosis of a surgically confirmed case of Valentino’s syndrome. J Clin Imaging Sci. 2014;4(28):28. doi: 10.4103/2156-7514.133263
Mbarushimana S, Morris-Stiff G, Thomas G. Atypical presentation of perforated peptic ulcer disease in a 12-year-old boy. BMJ Case Rep. 2014;2014:bcr2014204716-bcr2014204716. doi: 10.1136/bcr-2014-204716
Chung KT, Shelat VG. Perforated peptic ulcer - an update. World J Gastrointest Surg. 2017;9(1):1-12. doi: 10.4240/wjgs.v9.i1.1
Thorsen K, Søreide JA, Kvaløy JT, Glomsaker T, Søreide K. Epidemiology of perforated peptic ulcer: age- and gender-adjusted analysis of incidence and mortality. World J Gastroenterol. 2013;19(3):347-354. doi: 10.3748/wjg.v19.i3.347
Thorsen K, Glomsaker TB, von Meer A, Søreide K, Søreide JA. Trends in diagnosis and surgical management of patients with perforated peptic ulcer. J Gastrointest Surg. 2011;15(8):1329-1335. doi: 10.1007/s11605-011-1482-1.
Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84(2):102-113. doi: 10.1159/000323958.
Sultan R, Pal KMI. Valentino appendix: a report of 3 cases. J Pak Med Assoc. 2015;65(2):223-224.
Blundell S, Campbell A, Patel R, Besarovic S. Valentino’s syndrome in an adolescent boy with peptic ulcer perforation simulating acute appendicitis. J Pediatr Surg Spec. 2015;9(4):40-42.
Hussain K, Munir A, Wahla MS, Masood J. Valentino’s syndrome: Perforated peptic ulcer mimicking acute appendicitis managed through Rutherford Morrison incision. J Coll Physicians Surg Pak. 2016;26(8):727-728. doi: 2422
Ramírez-Ramírez MM, Villanueva-Saenz E. Valentino’s syndrome: Perforated peptic ulcer with unusual clinical presentation. Revista de Gastroenterología de México. 2016;81:225-226.
González Chávez AM, García Vázquez AA, Gómez López JM, et al. Valentino’s syndrome: the simulation of an appendicitis. Int Surg J. 2017;4(5):1813. doi: 10.18203/2349-2902.isj20171647
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.
Pata F, Sgro A, Petkar M, Benevento A. Valentino’s syndrome: An unusual presentation of a perforated peptic ulcer. Transl Surg. 2017;2(4):106. doi: 10.4103/ts.ts_16_17
Iloh AA, Omorogbe SO, Osime OC. Surgeons beware: It may not be acute appendicitis. Arch Int Surg. 2017;7(4):139. doi: 10.4103/ais.ais_41_17
Akiş Yildiz Z, Ayyildiz HN. Valentino’s syndrome in a child: Perforated peptic ulcer mimicking acute appendicitis. Turk J Pediatr Dis. 2018;12(4):287-288. doi: 10.12956/tjpd.2018.346
Mohan CP, Kabalimurthy J, Balamurugan E, Jayavarmaa R. A rare case of Valentino’s syndrome. International Surgery Journal. 2018;5:2933-2935.
Cherry BH, Patel D, Ronaghan JE. A case of Valentino’s syndrome presenting as possible appendicitis. Int Surg. 2019;104(11-12):540-541. doi: 10.9738/intsurg-d-17-00136.1
Phadnis RK, Sharma S, Patnala SL, Hussain F, Chigulapalli N. A Rare Case Of Valentino Syndrome- Case Report. Int J Med Biomed Stud. 2021;5(11). doi: 10.32553/ijmbs.v5i11.2301
Noussios G, Galanis N, Konstantinidis S, Mirelis C, Chatzis I, Katsourakis A. Valentino’s syndrome (with retroperitoneal ulcer perforation): A rare clinico-anatomical entity. Am J Case Rep. 2020;21:e922647-1–e922647-4. doi: 10.12659/ajcr.922647
Karthik G, Naga, Bala, Naik A. Retroperitoneal duodenal ulcer mimicking appendicitis associated with Valentino’s syndrome - A rare case report. Journal of Advanced Clinical and Research Insights. 2020;7(4):55-58. doi: 10.15713/ins.jcri.304
Lopez-Casillas N, Luna-Guerrero CE, Lopez-Rico LA, Vargas-Flores E. An Unusual Cause of Abdominal Pain: Valentino’s Syndrome. A Case Report. Japanese Journal of Gastroenterology and Hepatology. 2020;4(2):1-3.
Rodrigo VEU, de Silva G, Jayasinghe DSH, et al. Valentino’s syndrome: A rare and lethal differential diagnosis for acute appendicitis. SAGE Open Med Case Rep. 2022;10:2050313X2211320. doi: 10.1177/2050313x221132069
Devi T P, Selvi S M, Naveen B G, Kannan. Indian Journal of Research 2022;11(3):29-31. doi : 10.36106/Paripex.
Arumugam B, Giridharan B, Prabhakar, Shanmugasundaram. Syndrome Valentino from a DE Novo aetiology – acute pancreatitis. Cureus. 2022;14(1):e21360. doi: 10.7759/cureus.21360
Machaku D, Suleman M, Mduma E, Nkoronko M. Valentino’s syndrome: a bizarre clinical presentation. J Surg Case Rep. 2023;2023(2). doi: 10.1093/jscr/rjad035
Villamil-Angulo CJ, Pérez Calvo D, Villamil Castro NA, Rey Chaves CE, Conde D. Valentino’s syndrome: Simulation of acute appendicitis in the context of peptic ulcer perforation. Case report and literature review. Int J Surg Case Rep. 2023;105(108064):108064. doi: 10.1016/j.ijscr.2023.108064
Komatreddy GR, Gangam Venkat PR, Sai Teja K, Punyapu S. Valentino’s syndrome: a formidably deceptive tale of peptic ulcer. Int Surg J. 2023;10(2):325-328. doi: 10.18203/2349-2902.isj20230277
Ansari D, Torén W, Lindberg S, Pyrhönen HS, Andersson R. Diagnosis and management of duodenal perforations: a narrative review. Scand J Gastroenterol. 2019;54(8):939-944. doi: 10.1080/00365521.2019.1647456
Wang SY, Cheng CT, Liao CH, et al. The relationship between computed tomography findings and the locations of perforated peptic ulcers: it may provide better information for gastrointestinal surgeons. Am J Surg. 2016;212(4):755-761. doi: 10.1016/j.amjsurg.2015.05.022
Ishiguro T, Kumagai Y, Baba H, et al. Predicting the amount of intraperitoneal fluid accumulation by computed tomography and its clinical use in patients with perforated peptic ulcer. Int Surg. 2014;99(6):824-829. doi: 10.9738/intsurg-d-14-00109.1
Buck DL, Vester-Andersen M, Møller MH. Surgical delay is a critical determinant of survival in perforated peptic ulcer. Br J Surg. 2013;100(8):1045-1049. doi: 10.1002/bjs.9175
Tomtitchong P, Siribumrungwong B, Vilaichone RK, Kasetsuwan P, Matsukura N, Chaiyakunapruk N. Systematic review and meta-analysis: Helicobacter pylori eradication therapy after simple closure of perforated duodenal ulcer. Helicobacter. 2012;17(2):148-152. doi: 10.1111/j.1523-5378.2011.00928.x
Ng EKW, Lam YH, Sung JJY, et al. Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: Randomized controlled trial. Ann Surg. 2000;231(2):153-158. doi: 10.1097/00000658-200002000-00001
Gisbert JP, Pajares JM. Helicobacter pylori infection and perforated peptic ulcer prevalence of the infection and role of antimicrobial treatment. Helicobacter. 2003;8(3):159-167. doi: 10.1046/j.1523-5378.2003.00139.x
Bertleff MJOE, Lange JF. Perforated peptic ulcer disease: A review of history and treatment. Dig Surg. 2010;27(3):161-169. doi: 10.1159/000264653
Metzger J, Styger S, Sieber C, Vogelbach P, Harder F. Prevalence of Helicobacter pylori infection in peptic ulcer perforations. Swiss Med Wkly. 2001;131(7-8):99-103. doi: 10.4414/smw.2001.06118
Odisho T, Shahait AA, Sharza J, Ali AA. Outcomes of laparoscopic modified Cellan-Jones repair versus open repair for perforated peptic ulcer at a community hospital. Surg Endosc. 2023;37(1):715-722. doi: 10.1007/s00464-022-09306-7
Tai FWD, McAlindon ME. Non-steroidal anti-inflammatory drugs and the gastrointestinal tract. Clin Med. 2021;21(2):131-134. doi: 10.7861/clinmed.2021-0039
Kidwai R, Ansari MA. Graham patch versus Modified Graham patch in the management of perforated duodenal ulcer. J Nepalgunj Med Coll. 2017;13(1):28-31. doi: 10.3126/jngmc.v13i1.16409
Chou TC, Lee CH, Soong RS, Chen YC. A simple and effective technique for laparoscopic gastrorrhaphy: modified Graham’s patch with barbed suture. BMC Surg. 2023;23(1):295. doi: 10.1186/s12893-023-02192-3
Chung KT, Shelat VG. Perforated peptic ulcer - an update. World J Gastrointest Surg. 2017;9(1):1. doi: 10.4240/wjgs.v9.i1.1
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