Perforated peptic ulcer disease occasionally presents with symptoms similar to acute appendicitis due to leakage into the right iliac fossa (Valentino syndrome). The radiographic picture of pneumoperitoneum, intraperitoneal collection, and oral contrast leak is straightforward to the diagnosis of perforated peptic ulcer disease.

X-ray and Ultrasound contribution: Dr/ Somia Elbadawy

Intra-operative photos contribution: Dr/ Adel Abdelwahed