The eponym “Valentino's appendix” was first described in relation to the American actor, Rudolph Valentino. He underwent an appendectomy for acute appendicitis, later developing peritonitis and multiple organ failure that resulted in his death. Autopsy revealed a perforated gastric ulcer. The fluid originating from the perforated ulcer travels through the paracolic gutter to the right iliac fossa, causing peritoneal irritation in that quadrant. The presence of peri-appendicitis during surgery obliges the surgeon to rule out other pathologies and prevent catastrophic consequences.

A 29-year-old man presented with abdominal pain of 48h progression. The clinical interview, physical examination, and radiologic findings were consistent with complicated acute appendicitis (Fig. 1). Valentino's syndrome was diagnosed during laparoscopy (Figs. 2 and 3). Appendectomy was performed and primary closure was carried out with the Graham patch. Biopsy was taken, the cavity was washed, and drains were laparoscopically placed. The patient had adequate postoperative progression. Free subdiaphragmatic air was observed in the new analysis of the plain abdominal x-ray (Fig. 4).

Figure 1.

Plain abdominal x-ray with the patient in a standing position shows the fixed segment in the left hemiabdomen (white arrow) with image blurring.

(0.08MB).

Figure 2.

Hyperemic cecal appendix with fibrin and peri-appendicular fluid secondary to chemical peritonitis.

(0.12MB).

Figure 3.

A 5mm perforated duodenal ulcer on the anterior surface of the first part of the duodenum (white arrow).

(0.1MB).

Figure 4.

Right upper quadrant of the abdominal x-ray showing the hepatic silhouette (black arrow), diaphragm (white arrow), and the free subdiaphragmatic air (dotted white arrow).

(0.05MB).