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Signs of Appendicitis

 
 
 
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Overview

Appendicitis is an emergency that should be rapidly diagnosed and treated, however this is often difficult clinically - especially in female patients. Signs such as tenderness in McBurney's point as well as the Rosving sign can suggest acute appendicitis.

McBurney’s Point Tenderness

McBurney's point is the point of maximal tenderness in appendicitis.
  • Feel For

  • Tenderness in McBurney's point, exactly one third of the way between the right anterior superior iliac spine (ASIS) and the umbilicus.

Rovsing’s Sign

  • How to Elicit

  • Place inward and upward pressure onto the left iliac fossa. The sign is present if there is resulting pain in the right iliac fossa.
  • Significance

  • An uncommon sign of appendicitis.
Rovsing's sign was first noted by Niels Thorkild Rovsing in 1907, and has been shown to be an uncommon sign of appendicitis (Davey, 1956). The presumptive mechanism has been that antiperistaltic pressure on the descending colon results in backflow of gas through the transverse and ascending colon resulting in appendiceal irritation and pain. Yasui (1958) demonstrated intraoperatively that pressure on the left iliac fossa does not result in pressure change in the caecum, suggesting that a different mechanism may be responsible. One hypothesis is that pressure on the left iliac fossa causes rubbing of the sigmoid colon against an inflamed appendix resulting in pain.
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