A RARE CASE OF VALENTINO SYNDROME- CASE REPORT

Background: Valentino’s syndrome refers to acute abdomen with clinical presentation mimicking acute appendicitis in a Perforated gastric or duodenal ulcer. This occurs when suppurative fluid from duodenal perforation trickles down the paracolic gutter to the right iliac fossa causing peritonitis locally and causes periappendicitis. Less than 50 cases have been reported in literature of the same. Case report and discussion: A 42-year-old male was admitted to the general surgery department with pain in the right iliac fossa and epigastric region. A diagnostic laparoscopy was performed under the suspicion of Acute appendicitis, which was later converted to open laparotomy on finding a perforated duodenal ulcer. Review of Literature: Valentino syndrome is a rare condition in which a duodenal ulcer mimics acute appendicitis which is a diagnosed intraoperatively and managed surgically. Although the exact incidence is unknown, less than 50 cases have been reported worldwide. The first incidence reports back to 1926 when an Italian actor, Rodolfo Valentino who succumbed to this rare disease and it was named after him. Conclusion: Differential diagnosis of duodenal ulcer perforation should be considered for adult patient with diagnosis of acute appendicitis. X ray erect abdomen and diagnostic laparoscopy can help to overcome foot in mouth situation due to missed duodenal ulcer perforation. Keywords: Valentino syndrome.

Is Duodenal Ulcer Perforation in Adolescents Different from Duodenal Ulcer Perforation in Adults?

Background: Duodenal ulcer perforations (DUP) are missed in the differential diagnosis of acute abdomen because they are less common in children than in adults. Delay in diagnosis may cause morbidity or even mortality. It was aimed to raise awareness about DUP in adolescent by comparing the data of adolescent cases treated in our clinic with the adult cases' data in the literature. Objectives: We reviewed the clinical characteristics of nine male patients with DUP, ages between 14 and 17 years, admitted to our clinic between January 2007 and June 2020 retrospectively. Literature data on DUP in adults were reviewed. Methods: The obtained data were compared with the data of adult patients in the literature. Results: Patients were reported to have symptoms such as abdominal pain and vomiting that lasted for 1-30 days on average in 8 patients, and nonsteroidal anti-inflamatory drugs were used all patients except 2 patients. There was diffuse tenderness at the abdomen in all of the remaining patients and in 7 patients intraabdominal free air was observed. Perforation was repaired with omentoplasty in all patients. Unlike the adult population, DUP adolescents are more related to NSAID use rather than Helicobacter pylori infection and complicated surgical techniques were not required because the cases were generally not complicated. Conclusions: Although it is rarely seen in adolescents and shows certain differences compared to adult patients, the anamnesis and physical examination of the patients should direct the physicians to the DUP. Differences from adult population should be considered in diagnosis and treatment.

Zollinger ellison syndrome due to primary nodal gastrinoma located outside the limits of the conventional gastrinoma triangle: report of a case

Primary nodal gastrinoma is a rare entity and the diagnosis is often contemplative when no other non - nodal primary site can be identified despite thorough investigations and operative exploration. Here we report one such case wherein a primary nodal gastrinoma was diagnosed as an entity of exclusion. Additionally, the location of the disease outside the confines of the conventional gastrinoma triangle further contributes to the rarity of the presentation. A young male patient had presented to us with history of multiple operations in the past for recurrent upper abdominal pain presumably consequential to peptic ulcer disease viz a trucal vagotomy and gastrojejunostomy, duodenal ulcer perforation surgery and a cholecystectomy. CT scan and endoscopic USG showed a preaortic calcified node located outside the limits of the gastrinoma triangle. A raised serum gastrin level and an endoscopic guided FNAC confirmed the diagnosis of a gastrinoma. A 68 Ga-DOTANOC PET CT revealed an exclusive nodal uptake with no discenable primary lesion. Normalization of gastrin levels after removal of the involved pre-aortic node further pointed to the diagnosis of primary nodal gastrinoma. A high index of clinical suspicion is warranted especially in a history of multiple surgeries for recurrent upper abdominal pain and location of the lesion outside the confines of the ‘Gastrinoma Triangle’ should not be deterrent for the diagnosis.

Study of factors affecting mortality and morbidity in patients presenting with peritonitis due to duodenal ulcer perforation

Background: Peptic ulcer disease in the general population had lifetime prevalence of 5-10% with incidence of 0.1–0.3% per year. Despite the tremendous improvement in preventive therapies, the rate of complication of this disease is still high and is burdened by high morbidity and mortality. In present study, we aimed to study factors affecting mortality and morbidity in patients presenting with peritonitis due to duodenal ulcer perforation at our tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study conducted in patients admitted, diagnosed with duodenal ulcer perforation and surgically treated at our hospital. Results: In present study period total 56 patients were studied. All were male, most common age group was 51-60 years (37.5%) followed by 41-50 years (23.21%). Duration from onset of symptoms to admission was >24 hours (30.36%) in most of patients followed by 12-24 hours (28.57%). Most commons symptoms were pain in abdomen (100%), vomiting (100%). Anaemia (37.5%), LRTI and Pulmonary complications (19.64%), Diabetes mellitus (12.5%) and Hypertension (10.71%) were common comorbidities noted. Associated risk factors were previous history of PUD (41.07%), Alcohol use (64.29%), Cigarette smoking (51.79%) and Use of NSAIDs (12.5%). Presence of free gas under diaphragm was noted in 83.93% patients. Intraoperatively duodenal perforation diameter was 1–5 mm (60.71%) in most of patients followed by 6–10 mm (23.21%). Only 1 patient had duodenal perforation diameter was > 20mm. Common postoperative complications were wound infection (37.5%) and pulmonary infection (21.43%). In present study mortality within 1 month was noted in 13 patients (23.21%). Most common factors related to mortality were delayed presentation > 24 hours (61.54%), age > 60 years (46.15%), diabetes mellites (38.46%), Size of perforation > 1 cm (38.46%) and septicaemic shock (23.08%). Conclusion: Delayed presentation > 24 hours, age > 60 years size of perforation > 1 cm were common factors related to mortality in duodenal ulcer perforation patients.

Primary percutaneous coronary intervention without stenting using excimer laser and manual thrombectomy in STEMI with duodenal ulcer perforation: a case report

Background ST-segment elevation myocardial infarction (STEMI) and peptic ulcer perforation are both medical emergencies that require urgent intervention. In case that these time-sensitive medical emergencies present concomitantly, it remains unclear which one should be treated first. Case summary An 85-year-old man with melaena, epigastric pain, and severe anaemia was transferred to our emergency department and diagnosed as having inferior STEMI based on electrocardiogram. Emergency coronary angiography (CAG) revealed severe stenosis with thrombus in the proximal right coronary artery. Immediate oesophagogastroduodenoscopy and abdominal computed tomography detected the presence of duodenal ulcer perforation. Primary percutaneous coronary intervention (PCI) without stenting using excimer laser coronary angioplasty and manual thrombectomy was performed under intravascular ultrasound (IVUS) guidance to avoid dual antiplatelet therapy (DAPT). After successful PCI, the perforated viscus was surgically repaired with a laparoscopic omental patch. On Day 7, endoscopic haemostasis treated the oozing of blood from the duodenal ulcer. On Day 21, follow-up CAG and IVUS showed residual stenosis with organized thrombus in the culprit lesion, in which a drug-coated stent was directly implanted. He was discharged with a favourable clinical course on Day 23. Discussion We judged that PCI should take precedence over the surgical repair of perforated duodenal ulcer in our case since STEMI was an immediate life-threatening compared to the perforated viscus which had no active exsanguination. Excimer laser coronary angioplasty with manual thrombectomy might be an adequate option to avoid stent deployment and subsequent DAPT in such complex scenarios.

DUODENAL ULCER PERFPRATION - A CLINICAL STUDY IN A TERTIARY HEALTH CARE SET UP.

BACKGROUND - Peptic ulcer disease though having multifactorial etiologies, out of which H.pyroli infection and NSAIDs use are leading causes of duodenal perforation. Gastro-duodenal perforations are common in surgical practice. Acute perforations of duodenum are estimated to occur in 2-10% of patients with ulcers. MATERIALS AND METHODS - This a retrospective study ( done between August 2019 to August 2020), where 100 patients with duodenal ulcer perforation were enrolled, analyzed and compared in Department of General Surgery, Veer Surendra Sai Institute of Medical Science And Research (VIMSAR) , Burla, Sambalpur. RESULTS – More common in 40-59 years age group, male and lower socioeconomic status. CONCLUSION-Duodenal ulcer perforation is one of the most common acute abdominal emergencies.

Duodenal Ulcer Perforation in Pediatric Population: A Rare Entity

In pediatric age group peptic ulcer disease and duodenal perforation are usually rare condition. We report here a case of 3 years old girl who presented with upper abdominal pain, fever. On examination, she was febrile, tachycardia, with the feature of peritonitis. X-ray Abdomen reveled pneumoperitoneum. After resuscitation and investigating the child, a provisional diagnosis of peritonitis due to hollow viscus perforation was made. The child was planned for laparotomy. Intraoperative diagnosis of first portion of duodenum perforation was made and she underwent repair of perforation.