Rodolfo Valentino Syndrome: Perforated Duodenal Ulcer Mimicking Appendicitis

By Joel Joseph, MD and Klaus Mönkemüller, MD, PhD, FASGE, FJGES, FESGE
Department of Gastroenterology, Carilion Memorial Hospital, Virginia Tech Carilion School of Medicine, Roanoke, USA

Case Presentation: 80-year-old patient with history of lung cancer on immune checkpoint inhibitor therapy presented with acute right lower abdominal pain, elevated inflammatory markers and mild lactic acidosis. The patient had rebound pain in the right lower quadrant and right flank. CT showed free air below the liver (Figure 1). During laparotomy a perforated duodenal ulcer was found. The omentum had wrapped itself to the perforation, which was sealed. There were inflammatory adhesions globally to anterior abdominal wall, pus in the infrahepatic space and right paracolic gutter and ecrotic omentum adjacent to abscess cavity.

Valentino´s syndrome is a rare condition caused by irritation of the peritoneum due to fluid from a perforated ulcer migrating into the paracolic sulcus (1, 2). This situation may mimic acute appendicitis or other differential diagnoses of right lower quadrant pain such as ureteral colic, diverticulitis, diverticulum rupture, ovarian torsion, ruptured ectopic pregnancy, perforated cholecystitis, pancreatitis, and pelvic inflammatory disease (1-3).

Rodolfo Pietro Filiberto Raffaello Gugliemi di Valentina d`Antonguolla), a famous Italian-American actor who starred in several well-known silent films of the 1920s (1, 2). Known in Hollywood as the “Latin Lover”, he died in 1926 at the age of 31 from septic complications (peritonitis and pleuritis) of an undiagnosed perforated peptic ulcer. This ulcer simulated appendicular abdominal pain and was treated surgically with an appendectomy, the final diagnosis being made at autopsy (1, 2).