Valentino syndrome: A rare presentation disguised as acute appendicitis

Valentino syndrome is a rare condition where a perforated peptic or duodenal ulcer presents as right iliac fossa pain, mimicking acute appendicitis. We report the case of an 18-year-old male presenting with a one-day history of abdominal pain, initially in the upper abdomen and later localised to the right iliac fossa. Clinical examination revealed tenderness and guarding in the right iliac fossa. Ultrasonography suggested an inflamed appendix with minimal free fluid, raising suspicion for appendicitis. However, diagnostic laparoscopy revealed bilious purulent fluid and a grossly normal appendix. Further exploration identified a prepyloric perforation, which was repaired with a modified Graham's patch. The patient had an uneventful recovery and was discharged on postoperative day 5. This case highlights Valentino syndrome as a critical but under-recognised differential diagnosis in patients presenting with right iliac fossa pain. Awareness is essential to avoid misdiagnosis and unnecessary appendectomy. Prompt surgical intervention remains the cornerstone of management.