A Rare Clinical Condition Mimicking Acute Appendicitis: Valentino Syndrome

Öz

Objective: Valentino syndrome is a rare clinical entity that mimics acute appendicitis due to the retroperitoneal spread of a duodenal ulcer perforation. We present a case diagnosed preoperatively and treated laparoscopically. Methods: A 51-year-old man presented with acute abdominal pain radiating from the epigastrium to the right lower quadrant. Physical examination revealed upper-quadrant tenderness and rebound. Laboratory testing showed a mild elevation in C-reactive protein (4.1 mg/L). Results: Contrast-enhanced CT demonstrated intramural gas in the gastric antrum, inflammatory stranding within the periduodenal fat planes, free air anterior to the left hepatic lobe, and a reactively thickened appendix. A preoperative diagnosis of “Valentino appendicitis” was made. Laparoscopy confirmed a prepyloric perforation, which was repaired using a Graham patch. Appendectomy was not performed. Conclusion: Valentino syndrome can be recognized preoperatively through careful clinical and radiologic assessment.

Anahtar Kelimeler

• Valentino syndrome
• duodenal ulcer perforation
• acute appendicitis; preoperative diagnosis; laparoscopic surgery

Akut Apandisiti Taklit Eden Nadir Bir Klinik Durum: Valentino Sendromu

Öz

Amaç: Valentino sendromu, duodenal ülser perforasyonunun retroperitoneal yayılımı sonucu akut apandisiti taklit eden nadir bir klinik durumdur. Bu çalışmada preoperatif tanı konulup laparoskopik tedavi edilen bir olgu sunulmaktadır. Yöntemler: Elli bir yaşında erkek hasta, epigastriumdan sağ alt kadrana yayılan akut karın ağrısı ile başvurdu. Fizik muayenede üst kadranda hassasiyet ve rebound, laboratuvar tetkiklerinde hafif CRP yüksekliği (4.1 mg/L) izlendi. Bulgular: Kontrastlı BT'de gastrik antrumda intramural hava, periduodenal yağlı planlarda inflamasyon, sol hepatik lob anteriorunda serbest hava ve reaktif olarak kalınlığı artmış apendiks saptandı. Preoperatif olarak "Valentino apandisiti" tanısı konuldu. Laparoskopide prepilörik perforasyon doğrulandı ve Graham patch ile onarıldı. Apendektomi yapılmadı. Sonuç: Valentino sendromu, dikkatli klinik ve radyolojik değerlendirme ile preoperatif olarak tanınabilir; bu sayede apendiks-koruyucu cerrahi uygulanabilir.

Anahtar Kelimeler

• Valentino sendromu
• duodenal ülser perforasyonu
• akut apandisit
• preoperatif tanı
• laparoskopik cerrahi

Kaynakça

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