From the Research
A positive Rovsing sign is a significant indicator of acute appendicitis, suggesting the need for urgent surgical evaluation to prevent complications such as perforation and peritonitis. This clinical finding occurs when pressure applied to the left lower quadrant of the abdomen causes pain in the right lower quadrant (specifically at McBurney's point) 1. The significance lies in its ability to help diagnose appendicitis without directly palpating the inflamed area. Physiologically, when the examiner presses on the left side, this displaces gas and contents in the colon toward the cecum and irritated appendix, causing pain at the site of inflammation.
Clinical Significance
The Rovsing sign is particularly valuable when combined with other clinical findings such as:
- Fever
- Right lower quadrant tenderness
- Rebound pain
- Elevated white blood cell count These signs help clinicians determine the likelihood of acute appendicitis and the need for prompt surgical intervention 1. However, the sign should not be used in isolation for diagnosis, as other conditions like pelvic inflammatory disease or Crohn's disease can occasionally produce similar findings.
Diagnostic Approach
The diagnosis of acute appendicitis involves a combination of clinical evaluation, laboratory tests, and imaging studies. The Alvarado score, Pediatric Appendicitis Score, and Appendicitis Inflammatory Response score can help stratify patients as low, moderate, or high risk for acute appendicitis 1. Ultrasonography is recommended as the first-line imaging modality for suspected acute appendicitis.
Management
Appendectomy via open laparotomy or laparoscopy is the standard treatment for acute appendicitis. However, intravenous antibiotics may be considered first-line therapy in selected patients 1. Pain control with opioids, nonsteroidal anti-inflammatory drugs, and acetaminophen should be a priority and does not result in delayed or unnecessary intervention. Prompt surgical consultation is crucial to reduce morbidity and mortality resulting from perforation.