Valentino's syndrome

In medicine, Valentino's syndrome is pain presenting in the right lower quadrant of the abdomen caused by a duodenal ulcer with perforation through the retroperitoneum.[1]

It is named after Rudolph Valentino who presented with right lower quadrant pain which turned out to be a perforated peptic ulcer. He subsequently died from an infection in spite of surgery to repair the perforation.[2] The pain is caused by gastric and duodenal fluids that tend to settle in the right paracolic gutter causing peritonitis and RLQ pain.[2][3]

Patients with perforated Valentino's syndrome usually present with a sudden onset of severe, sharp abdominal pain which is reminiscent of appendicitis.[4] Most patients describe generalized pain; a few present with severe epigastric pain. As even slight movement can tremendously worsen their pain, these patients assume a fetal position. Abdominal examination usually discloses generalized tenderness, rebound tenderness, guarding, and rigidity. However, the degree of peritoneal findings is strongly influenced by a number of factors, including the size of perforation, amount of bacterial and gastric contents contaminating the abdominal cavity, time between perforation and presentation, and spontaneous sealing of perforation.

These patients may also demonstrate signs and symptoms of septic shock, such as tachycardia, hypotension, and anuria. Not surprisingly, these indicators of shock may be absent in elderly or immunocompromised patients or in those with diabetes. Patients should be asked if retching and vomiting occurred before the onset of pain.

References

  1. ↑ DeVirgilio, Christian; Grigorian, Areg (2017). Review of Surgery for ABSITE and Boards E-Book. Elsevier Health Sciences. p. 113. ISBN 9780323416801.
  2. 1 2 M, Sriram Bhat (2016). SRB's Manual of Surgery. JP Medical Ltd. p. 831. ISBN 9789351524168.
  3. ↑ Williams, Norman; O'Connell, P. Ronan (2013). Bailey & Love's Short Practice of Surgery 26E. CRC Press. p. 971. ISBN 9781444165029.
  4. ↑ Acute Appendicitis: New Insights for the Healthcare Professional: 2013 Edition: ScholarlyBrief. ScholarlyEditions. 2013. p. 36. ISBN 9781481650380. Retrieved 31 October 2017.


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