Valentino's syndrome: diagnostic challenge of acute lower abdominal pain

Acute lower abdominal pain poses a diagnostic challenge, with several potentially life-threatening causes. Although peptic ulcer perforation typically presents with upper abdominal pain, it can rarely mimic acute appendicitis-a phenomenon known as Valentino's syndrome. We report a case from a resource-limited setting, where a patient presenting with right lower quadrant pain was initially diagnosed with acute appendicitis. Intraoperatively, the appendix appeared normal, but a purulent collection was noted in the right iliac fossa. Extending the incision revealed a perforated duodenum, confirming Valentino's syndrome. This case highlights the importance of considering atypical presentations and maintaining a broad differential diagnosis in acute abdomen, particularly in resource-limited settings where preoperative imaging may be limited.