{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T16:16:08Z","timestamp":1764260168948,"version":"3.46.0"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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\u2014a phenomenon known as Valentino\u2019s 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\u2019s 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.<\/jats:p>","DOI":"10.1093\/jscr\/rjaf934","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T13:09:28Z","timestamp":1762520968000},"source":"Crossref","is-referenced-by-count":0,"title":["Valentino\u2019s syndrome: diagnostic challenge of acute lower abdominal pain"],"prefix":"10.1093","volume":"2025","author":[{"given":"Rajan Narayan","family":"Nakarmi","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Institute of Medicine, Tribhuvan University , Kathmand-44600, Bagmati Province,","place":["Nepal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5276-3494","authenticated-orcid":false,"given":"Bishal","family":"Budha","sequence":"additional","affiliation":[{"name":"Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University , Kathmand-44600, Bagmati Province,","place":["Nepal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roshan","family":"Chaudhary","sequence":"additional","affiliation":[{"name":"Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University , Kathmand-44600, Bagmati Province,","place":["Nepal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sushil","family":"Sah","sequence":"additional","affiliation":[{"name":"Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University , Kathmand-44600, Bagmati Province,","place":["Nepal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satish","family":"Bajracharya","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Institute of Medicine, Tribhuvan University , Kathmand-44600, Bagmati Province,","place":["Nepal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aashish","family":"Pandey","sequence":"additional","affiliation":[{"name":"Manmohan Cardiothoracic Vascular and Transplant Center , Tribhuvan University, Maharajgunj, Kathmand-44600, Bagmati Province,","place":["Nepal"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"2025112711044055300_ref1","doi-asserted-by":"publisher","article-title":"Valentino\u2019s syndrome \u2013 a systematic review of a life-threatening mimic of acute appendicitis","author":"Salati","DOI":"10.15584\/ejcem.2024.4.15"},{"key":"2025112711044055300_ref2","first-page":"44","article-title":"Valentino\u2019s syndrome: a life-threatening mimic of acute appendicitis","volume":"1","author":"Amann","year":"2017","journal-title":"Clin Pract Cases Emerg Med"},{"key":"2025112711044055300_ref3","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1111\/1744-1633.12673","article-title":"What is Valentino\u2019s syndrome?","volume":"28","author":"Pappas","year":"2024","journal-title":"Surg Pract"},{"key":"2025112711044055300_ref4","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1086\/649554","article-title":"Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the surgical infection society and the Infectious Diseases Society of America","volume":"50","author":"Solomkin","year":"2010","journal-title":"Clin Infect Dis Off Publ Infect Dis Soc Am"},{"key":"2025112711044055300_ref5","doi-asserted-by":"publisher","first-page":"S6","DOI":"10.1016\/S0022-510X(98)00193-2","article-title":"Diagnosis of amyotrophic lateral sclerosis","volume":"160","author":"Rowland","year":"1998","journal-title":"J Neurol Sci"},{"key":"2025112711044055300_ref6","article-title":"The acute abdomen \u2013 commonly missed and mis-diagnosed conditions: review","volume-title":"WebmedCentral","author":"Durai R, Hoque H, Ng P"},{"key":"2025112711044055300_ref7","doi-asserted-by":"publisher","first-page":"2933","DOI":"10.18203\/2349-2902.isj20183219","article-title":"A rare case of Valentino\u2019s syndrome","volume":"5","author":"Mohan","year":"2018","journal-title":"Int Surg J"},{"key":"2025112711044055300_ref8","doi-asserted-by":"publisher","article-title":"Valentino's syndrome a perforated peptic ulcer mimicking acute appendicitis","volume-title":"BMJ Case Rep","DOI":"10.1136\/bcr.03.2012.6015"},{"key":"2025112711044055300_ref9","doi-asserted-by":"publisher","DOI":"10.4103\/ais.ais_41_17","article-title":"Surgeons beware: It may not be acute appendicitis","volume":"7","journal-title":"Archives of International Surgery"},{"key":"2025112711044055300_ref10","doi-asserted-by":"publisher","first-page":"bcr2014204716","DOI":"10.1136\/bcr-2014-204716","article-title":"Atypical presentation of perforated peptic ulcer disease in a 12-year-old boy","volume":"2014","author":"Mbarushimana","year":"2014","journal-title":"BMJ Case Rep"},{"key":"2025112711044055300_ref11","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1111\/j.1365-2036.2009.04086.x","article-title":"Review article: cellular and molecular mechanisms of NSAID-induced peptic ulcers","volume":"30","author":"Musumba","year":"2009","journal-title":"Aliment Pharmacol Ther"},{"key":"2025112711044055300_ref12","doi-asserted-by":"publisher","first-page":"28","DOI":"10.4103\/2156-7514.133263","article-title":"First report of preoperative imaging diagnosis of a surgically confirmed case of Valentino\u2019s syndrome","volume":"4","author":"Mahajan","year":"2014","journal-title":"J Clin Imaging Sci"},{"key":"2025112711044055300_ref13","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.ajem.2004.04.037","article-title":"A pregnant woman presenting to the ED with Valentino\u2019s syndrome","volume":"23","author":"Hsu","year":"2005","journal-title":"Am J Emerg Med"},{"key":"2025112711044055300_ref14","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1007\/s00464-004-8866-1","article-title":"Early laparoscopy as a routine procedure in the management of acute abdominal pain: a review of 1,320 patients","volume":"19","author":"Golash","year":"2005","journal-title":"Surg Endosc"},{"key":"2025112711044055300_ref15","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1111\/j.1523-5378.2011.00928.x","article-title":"Systematic review and meta-analysis: helicobacter pylori eradication therapy after simple closure of perforated duodenal ulcer","volume":"17","author":"Tomtitchong","year":"2012","journal-title":"Helicobacter"},{"key":"2025112711044055300_ref16","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1002\/bjs.1800740203","article-title":"Perforated duodenal ulcer","volume":"74","author":"Raimes","year":"1987","journal-title":"Br J Surg"},{"key":"2025112711044055300_ref17","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1159\/000264653","article-title":"Perforated peptic ulcer disease: a review of history and treatment","volume":"27","author":"Bertleff","year":"2010","journal-title":"Dig Surg"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2025\/11\/rjaf934\/65572509\/rjaf934.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2025\/11\/rjaf934\/65572509\/rjaf934.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T16:04:48Z","timestamp":1764259488000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjaf934\/8346080"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,1]]},"references-count":17,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjaf934","relation":{},"ISSN":["2042-8812"],"issn-type":[{"value":"2042-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,11,1]]},"article-number":"rjaf934"}}