Valentino Syndrome With Histologically Confirmed Acute Appendicitis: A Rare Dual Pathology

Acute abdomen is a common surgical emergency with multiple etiologies; acute appendicitis and perforated peptic ulcer (PPU) are among the common. Valentino's syndrome is a rare condition in which patients with PPU present with clinical features of acute appendicitis due to the flow of gastric contents along the right paracolic gutter, causing inflammation of the appendix. Diagnosis is often delayed and made during surgery. We discuss a case of a 25-year-old male who presented with acute pain in the right lower quadrant. Initial assessment pointed toward acute appendicitis; however, on further evaluation, the patient was found to have a perforated prepyloric ulcer with 500 mL of seropurulent peritoneal fluid and an inflamed appendix. He underwent Graham's patch repair of the prepyloric ulcer along with peritoneal lavage and appendectomy. Histopathology of the appendix revealed features suggestive of acute appendicitis, and biopsy from the prepyloric ulcer revealed an active ulcer with few Helicobacter ​​​​​pylori-like organisms, hence supporting the diagnosis of H. pylori-associated peptic ulcer. Post-operatively, the patient was initiated on H. pylori eradication therapy, and his recovery was uneventful. This case highlights the importance of clinical assessment and remaining alert for other possible etiologies of right lower quadrant pain in atypical presentations. Valentino's syndrome, although rare, must still be considered in such cases of right lower quadrant pain with discrepancies in initial investigations and clinical findings. Often, Valentino's syndrome is treated as acute appendicitis; however, prompt re-assessment and in-depth evaluation of the patient followed by timely surgical intervention can lead to optimal outcomes.