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Peer-reviewedCC BYJournal of surgical case reports

Valentino's syndrome with secondary appendiceal perforation and fungal involvement.

  • Nicholas Wijaya1
  • Hanif Ardiansyah Sulistya1
  • Wahju Sigit Tjahjono Putro2
  • Jauhar Tajudin1
  • Aditya Rachmat Febrianto2,3
  • Clarishella Melvina Deinera1
  • Budi Prakoso4
  • Wisniardhy Suarnata Pradana5
  • Muhammad Rodli6
  • Neviana Fitri Lestari7
  • Nayla Rahmadiani8
  • Mohammad Agung Marzah9
9 affiliations
  1. 1Emergency Department, Dr. Soepraoen Army Hospital, Jl. S. Supriadi No. 22, Sukun, Malang 65147, Indonesia.
  2. 2Department of Surgery, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar General Academic Hospital, Jl. Jaksa Agung Suprapto No. 2, Klojen, Malang 65111, Indonesia.
  3. 3Department of General Surgery, Dr. Soepraoen Army Hospital, Jl. S. Supriadi No. 22, Sukun, Malang 65147, Indonesia.
  4. 4Department of Internal Medicine, Dr. Soepraoen Army Hospital, Jl. S. Supriadi No. 22, Sukun, Malang 65147, Indonesia.
  5. 5Department of Radiology, Dr. Soepraoen Army Hospital, Jl. S. Supriadi No. 22, Sukun, Malang 65147, Indonesia.
  6. 6Department of Anesthesiology and Intensive Therapy, Dr. Soepraoen Army Hospital, Jl. S. Supriadi No. 22, Sukun, Malang 65147, Indonesia.
  7. 7Department of Anatomical Pathology, Dr. Soepraoen Army Hospital, Jl. S. Supriadi No. 22, Sukun, Malang 65147, Indonesia.
  8. 8Department of Anatomical Pathology, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar General Hospital, Jl. Jaksa Agung Suprapto No. 2, Klojen, Malang 65111, Indonesia.
  9. 9Department of Clinical Microbiology, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar General Hospital, Jl. Jaksa Agung Suprapto No. 2, Klojen, Malang 65111, Indonesia.
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Abstract

Valentino's syndrome (VS) is a rare presentation of perforated peptic ulcer disease causing right lower quadrant (RLQ) pain mimicking acute appendicitis. Secondary appendiceal perforation with fungal colonization is exceptionally uncommon. A 65-year-old woman presented with worsening RLQ pain, nausea, vomiting, diffuse peritoneal irritation, McBurney tenderness, and hemodynamic instability. Contrast-enhanced computed tomography demonstrated pneumoperitoneum, a pre-pyloric gastric wall defect, and periappendiceal inflammation suggestive of VS. Exploratory laparotomy confirmed generalized peritonitis from pre-pyloric gastric perforation with contamination tracking along the right paracolic gutter. A retrocecal appendix with secondary tip perforation further obscured the diagnosis. Appendectomy and primary gastric repair were performed. Histopathology showed extensive necrosis and fungal hyphae morphologically consistent with Aspergillus spp. on Grocott-Gomori methenamine silver staining, interpreted as secondary fungal involvement. This case broadens the clinical spectrum of VS and highlights careful histopathological interpretation in severely necrotic tissue.

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Cite

BibTeXRIS
BibTeX
@article{wijaya2026valentinos,
  title = {{Valentino's syndrome with secondary appendiceal perforation and fungal involvement.}},
  author = {Nicholas Wijaya and Hanif Ardiansyah Sulistya and Wahju Sigit Tjahjono Putro and Jauhar Tajudin and Aditya Rachmat Febrianto and Clarishella Melvina Deinera and Budi Prakoso and Wisniardhy Suarnata Pradana and Muhammad Rodli and Neviana Fitri Lestari and Nayla Rahmadiani and Mohammad Agung Marzah},
  journal = {Journal of surgical case reports},
  year = {2026},
  month = oct,
  doi = {10.1093/jscr/rjag945},
  url = {https://europepmc.org/article/MED/42948013},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Valentino's syndrome with secondary appendiceal perforation and fungal involvement.
AU  - Nicholas Wijaya
AU  - Hanif Ardiansyah Sulistya
AU  - Wahju Sigit Tjahjono Putro
AU  - Jauhar Tajudin
AU  - Aditya Rachmat Febrianto
AU  - Clarishella Melvina Deinera
AU  - Budi Prakoso
AU  - Wisniardhy Suarnata Pradana
AU  - Muhammad Rodli
AU  - Neviana Fitri Lestari
AU  - Nayla Rahmadiani
AU  - Mohammad Agung Marzah
PY  - 2026
DA  - 2026/10/27
JO  - Journal of surgical case reports
DO  - 10.1093/jscr/rjag945
UR  - https://europepmc.org/article/MED/42948013
AB  - Valentino's syndrome (VS) is a rare presentation of perforated peptic ulcer disease causing right lower quadrant (RLQ) pain mimicking acute appendicitis. Secondary appendiceal perforation with fungal colonization is exceptionally uncommon. A 65-year-old woman presented with worsening RLQ pain, nausea, vomiting, diffuse peritoneal irritation, McBurney tenderness, and hemodynamic instability. Contrast-enhanced computed tomography demonstrated pneumoperitoneum, a pre-pyloric gastric wall defect, and periappendiceal inflammation suggestive of VS. Exploratory laparotomy confirmed generalized peritonitis from pre-pyloric gastric perforation with contamination tracking along the right paracolic gutter. A retrocecal appendix with secondary tip perforation further obscured the diagnosis. Appendectomy and primary gastric repair were performed. Histopathology showed extensive necrosis and fungal hyphae morphologically consistent with Aspergillus spp. on Grocott-Gomori methenamine silver staining, interpreted as secondary fungal involvement. This case broadens the clinical spectrum of VS and highlights careful histopathological interpretation in severely necrotic tissue.
SN  - 2042-8812
ER  -