IMAGE CHALLENGE

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• IMAGE CHALLENGE
• OF THE WEEK

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• 72-year-old man presented to the ER.
• Severe RIGHT LOWER QUADRANT tenderness
• Recent use of NSAIDS for a cold.
• Previously treated H. Pylori infection.

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• What is the causative pathology here?
• What is the name of the syndrome?

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• CT showed air surrounding the right kidney
  (arrows) and extending to the retroperitoneum.
  Thickening of the wall at the second and third
  portions of the duodenum was also noted.
• Endoscopy showed multiple gastric and duodenal
  ulcers.
• Valentino's syndrome A duodenal ulcer with
  retroperitoneal perforation presenting with pain
  in the right lower quadrant was diagnosed.
• Veiled right kidney sign Artefact on
  transabdominal ultrasonography showing that the
  right kidney is masked by air in the
  retroperitoneum.
• The patient was treated with parenteral
  antibiotics without surgical intervention. His
  fever subsided in one day, and his recovery was
  uneventful. 

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• Student Question
• What are the retroperitoneal structures?

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Retroperitoneal Structures

• SAD PUCKERSuprarenal glandsAorta IVC
  Duodenum (2nd and 3rd are retroperitoneal)
• PancreasUretersColon (ascending, descending
  and sigmoid)KidneysEsophagus (anterior left
  covered)Rectum (anterior upper and middle 1/3rd
  only)

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