Rovsing's Sign: Definition and Clinical Significance
Rovsing's sign is a clinical finding in which palpation of the left lower quadrant of the abdomen causes pain in the right lower quadrant, indicating irritation of the peritoneum typically associated with acute appendicitis. This sign is named after Danish surgeon Niels Thorkild Rovsing (1862-1927), who first described it 1.
Proper Technique for Eliciting Rovsing's Sign
- The correct technique involves applying pressure to the left lower quadrant of the abdomen, which causes pain in the right lower quadrant due to the shifting of intestinal contents against an inflamed appendix 2
- This sign is based on the principle that pressure on the left side causes movement of gas or fluid in the colon, which then irritates the inflamed appendix on the right side 2
- It is important to note that there has been significant inconsistency in how this sign is described and performed in medical literature, leading to potential errors in its application 3
Diagnostic Value in Appendicitis
- Rovsing's sign is one of several clinical indicators used in the diagnosis of acute appendicitis, which is the most frequent cause of right upper quadrant abdominal pain requiring surgical intervention 4
- The absence of Rovsing's sign does not rule out appendicitis, as it is absent in approximately 68% of pediatric patients with confirmed appendicitis 5
- When positive, Rovsing's sign increases the likelihood of ruling in acute appendicitis, but a negative test is less helpful in ruling out the disease 2
- Rovsing's sign should be used in conjunction with other clinical findings, laboratory tests, and imaging studies for a more accurate diagnosis of appendicitis 4
Similar Clinical Signs
- L-sign in appendicitis is similar to Rovsing's sign but is elicited on the right side of the lateral abdominal wall 6
- Other important clinical signs in the evaluation of suspected appendicitis include the sonographic Murphy sign, which has relatively low specificity for acute cholecystitis 7
- The presence of right upper quadrant pain, nausea, vomiting, anorexia, and fever are common symptoms of acute cholecystitis, which should be considered in the differential diagnosis 4
Clinical Considerations
- Ultrasound is the first-line imaging modality for suspected biliary disease presenting with right upper quadrant pain, with a reported accuracy of 96% for detection of gallstones 4
- In cases where appendicitis is suspected but the diagnosis remains uncertain after clinical examination, abdominal imaging is recommended to confirm the diagnosis 4, 7
- It's important to recognize that many patients, especially children, may present with atypical features of appendicitis, making the diagnosis challenging 5
Historical Context
- Niels Thorkild Rovsing was a prominent Danish surgeon who made significant contributions to urological surgery and was a strong advocate for antisepsis 1
- He founded the Danish Surgical Society in 1908 and served briefly as Denmark's Minister of Education in 1920 1
- His other eponyms include Rovsing syndrome (abdominal pain in horseshoe kidney) and Rovsing operations for polycystic kidney and horseshoe kidney 1
Rovsing's sign remains a valuable clinical tool in the assessment of patients with suspected appendicitis, though it should be performed correctly and interpreted within the context of the patient's overall clinical presentation.