PMC4078456_01
21-year-old man with an 8-h history of severe right lower abdominal pain, epigastric pain, vomiting, and fever, diagnosed with Valentino's syndrome. Post contrast computed tomography (CT) scan of abdomen, coronal reformatted image shows air in the retroperitoneum on the right, predominantly around the right kidney (arrow). Normal right renal parenchyma is noted.
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F1
CT scan of abdomen and pelvis without and with intravenous (IV) contrast [Figures 1 and 2] revealed air in the retroperitoneum (pneumoretroperitoneum), predominantly around the right kidney. The retroperitoneal space in relation to the second part of the duodenum and the right kidney showed moderate inflammatory reaction evidenced by edema of the posterior peritoneum in that area [Figure 4 and Video 1]. A J-Vac (Ethicon) drain was placed in the subhepatic region and the abdomen was closed in layers [Figure 4 and Video 1].
21-year-old man with an 8-h history of severe right lower abdominal pain, epigastric pain, vomiting, and fever diagnosed with Valentino's syndrome. (a-d) Serial post contrast axial computed tomography (CT) scans of abdomen (a) Above the level of renal hila demonstrating the first part of duodenum; (b) At the level of renal hila demonstrating the second part of duodenum; (c) Just below the level of renal hila; and d): At left infrarenal level show significant fat stranding and air in and around the region of the duodenum (solid black arrow), duodenal wall thickening (white arrow), significant fat stranding, retroperitoneal fluid collection, and air in the subhepatic region (hollow black arrow).
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F2
CT scan of abdomen and pelvis without and with intravenous (IV) contrast [Figures 1 and 2] revealed air in the retroperitoneum (pneumoretroperitoneum), predominantly around the right kidney.
21-year-old man with an 8-h history of severe right lower abdominal pain, epigastric pain, vomiting, and fever diagnosed with Valentino's syndrome. Chest radiograph (frontal view) shows right perinephric air (arrow).
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F3
The chest radiograph revealed air around the visualized part of the right kidney [Figure 3].
21-year-old man with an 8-h history of severe right lower abdominal pain, epigastric pain, vomiting, and fever diagnosed with Valentino's syndrome. Intraoperative photographs show (a) retroperitoneal duodenum and the peritoneal rent (white arrow) and (b) shows the perforation in the anterior wall of the duodenum (black arrow). (GB: Gall bladder).
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F4
The retroperitoneal space in relation to the second part of the duodenum and the right kidney showed moderate inflammatory reaction evidenced by edema of the posterior peritoneum in that area [Figure 4 and Video 1]. A J-Vac (Ethicon) drain was placed in the subhepatic region and the abdomen was closed in layers [Figure 4 and Video 1].