Rovsing sign: In acute appendicitis, palpation of the left lower quadrant may elicit pain in the right lower quadrant. If this occurs, it is said to be a positive Rovsing sign.
This is commonly taught to be attributable to eliciting peritoneal irritation, however, Rovsing’s original description and intention was quite different…
History of the Rovsing Sign
Rovsing originally described the manoeuvre as an attempt to distend the caecum and appendix by applying pressure to the left colon, in an anti-peristaltic fashion. Described in a paper in 1907:
‘I press with my right hand onto the fingers of the left hand that is lying flat against the colon descendens and then let the hand glide up toward the splenic flexure…The entire method is based upon isolated rise of pressure within the colon.’
In doing this correctly, Rovsing suggests that if pain is elicited, then this isolates the source to the caecum or appendix, and rules out other structures in the right iliac fossa.
- Niels Thorkild Rovsing (1862-1927)
- Modern day application of sign compared to historic intention
- Rovsing T. Indirektes Hervorrufen des typischen Schmerzes an McBurney’s Punkt. Ein Beitrag zur Diagnostik der Appendicitis und Typhlitis [Indirect elicitation of the typical pain at McBurney’s point. A contribution to the diagnosis of appendicitis and typhlitis]. Zentralblatt für Chirurgie 1907;34:1257-59 [Rovsing sign]
- Lewis, SRR. Appendicitis BMJ 2011;343:d5976 [BMJ text]
- Hognason K, M.S., Swan KG, M.D. Niels Thorkild Rovsing: the Surgeon Behind the Sign. Am Surg 2014 12;80(12):1201-1206 [PMID 25513917]
- Smith, PH. The Diagnosis of Appendicitis. Postgrad Med J. 1965 Jan; 41(471): 2–5. [PMC 2483159]