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.
It is also referred to as the Perman-Rovsing sign, or the Perman sign.
History of the Perman-Rovsing Sign
1904 – Emil S. Perman published his original brief description of pain located to the ileoecal tract with pressure in the left part of the abdomen with appendicitis.
His findings were published in a paper, titled “Om indikationerna för operation vid appendicit samt redogörelse for å Sabbatsbergs sjukhus opererade fall“, detailing 244 cases of appendicitis between 1899-1904 at Sabbatsberg Hospital in Sweden, and the indications of surgery in appendicitis. His original description appears on page 806 of the article:
Därpå har jag äfven alltid funnit ett annat symtom tyda, nämligen en till ileooekaltrakten lokaliserad smärta vid tryck å- vänstra delen af buken.Furthermore, I have always found another symptom evident, namely a pain located to the ileocaecal tract with pressure to the left part of the abdomen. – Perman, 1904
1907 – 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 1907 description by Rovsing, but rather the description offered by Perman in 1904. 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.
- Perman ES. Om indikationerna för operation vid appendicit samt redogörelse for å Sabbatsbergs sjukhus opererade fall. Hygiea 1904; 66(2): 797-847 [Perman symptom p806] Tranlsation: 𝖬𝖺𝖽𝗌 𝖠𝗌𝗍𝗏𝖺𝖽
- 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 [Bastedo sign]
- 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