RETROPERITONEAL DUODENAL ULCER MIMICKING APPENDICITIS ASSOCIATED WITH VALENTINO’S SYNDROME.

Abstract

Valentino syndrome is a rare presentation of perforated peptic ulcer in retroperitoneum,which can present as right iliac fossa pain mimicking acute appendicitis(AA).The purpose of this report is to emphasise on rare presentation of right iliac fossa (RIF)tenderness In a suspected case of acute appendicitis,later diagnosed it to be Valentino’s syndrome.We reported a case of 22 years old male patient presented to emergency with complaints of pain in the right groin with fever.The diagnosis was inconclusive after routine investigations and clinical examination later proceeded with contrast enhanced computed tomography which reveals air pockets around right kidney and retro pneumoperitoneum and free fluid in the Morrisons pouch.An exploratory laparotomy revealed a perforation of peptic ulcer in the second part of duodenum which was closed by grahams omental patch repair.post operatively antibiotics were prescribed and the patient was discharged without any complications.A differential diagnosis of Valentino syndrome for perforated duodenal ulcer must be considered,while examining a case of pain in the RIF.The final diagnosis may be intraoperative,however,contrast enhanced computed tomography scans remains gold standard ones.valentino’s syndrome occurs when gastric and duodenal fluids collect in the right paracolic gutter causing focal peritonitis and RLQ pain.