Rovsing sign: The current use of this eponymous sign describes right lower quadrant pain elicited by palpation of the left lower quadrant in acute appendicitis. If this occurs, it is said to be a positive Rovsing sign.
History of the Rovsing Sign
Although this sign is commonly taught to be attributable to eliciting peritoneal irritation, Rovsing’s original description and intention were quite different. 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.
I press with my right hand onto the fingers of the left hand that is lying flat against the colon descendens [descending colon] and then let the hand glide up toward the splenic flexure…The entire method is based upon isolated rise of pressure within the colon.Rovsing 1907
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.
The Rovsing sign is described variably in medical literature with most descriptions bearing little/no resemblance to the original description by Rovsing. Prosenz et al reviewed 1178 individual studies and found no included study correctly described the method of eliciting Rovsing sign. Of 9 textbooks reviewed, 3 English texts on surgery failed to described the sign accurately, however all 6 German (text)books provided an accurate description.
- 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]
- Bastedo WA. The dilatation test for chronic appendicitis. American Journal Of The Medical Sciences. 1911; 142: 11-14
- Hertz AF. Bastedo’s sign: A new sign of chronic appendicitis. Lancet 1913; 181(4673): 816-817
- Davey WW. Rovsing’s sign. Br Med J. 1956; 2(4983): 28-30.
- Smith PH. The Diagnosis of Appendicitis. Postgrad Med J. 1965 Jan; 41(471): 2–5.
- Ráf L. Skandinaviska kirurger först med beskrivning av tecken pâ appendicit. [The men behind the syndrome: Emil Perman and Nils Thorkild Rovsing. Scandinavian surgeons were the first to describe signs of appendicitis] Läkartidningen 1984; 81(32-33): 2829-30
- Lewis, SRR. Appendicitis BMJ 2011; 343: d5976
- Hognason K, Swan KG. Niels Thorkild Rovsing: the Surgeon Behind the Sign. Am Surg 2014 12;80(12):1201-1206
- Prosenz J, Hirtler L. Rovsing sign revisited-effects of an erroneous translation on medical teaching and research. J Surg Educ. 2014 Sep-Oct;71(5):738-42
- Eponymythology: Appendicitis eponymous signs. LITFL
the names behind the name