From the Research
Kehr sign is a critical diagnostic indicator of intra-abdominal bleeding, particularly in cases of splenic rupture, and immediate medical attention is necessary when this sign is present, as it may indicate internal bleeding requiring surgical intervention. This sign is characterized by pain in the left shoulder that occurs due to irritation of the diaphragm from blood or other fluid in the peritoneal cavity, which causes blood to accumulate under the diaphragm and irritate the phrenic nerve, referring pain to the shoulder 1. The pain typically worsens when the patient is lying flat and may improve when sitting upright, as this position reduces diaphragmatic irritation. Other conditions that can cause Kehr sign include ectopic pregnancy with rupture, liver laceration, or any condition causing hemoperitoneum.
Some key points to consider when evaluating Kehr sign include:
- The sign is most commonly associated with a ruptured spleen, which is a life-threatening condition that requires prompt medical attention 2, 1.
- The pain associated with Kehr sign can be severe and may be accompanied by other symptoms such as abdominal pain, nausea, and vomiting 1.
- Computed tomography is the investigation of choice in cases of suspected splenic rupture or other conditions that may cause Kehr sign 2.
- During physical examination, physicians should specifically ask about shoulder pain when abdominal trauma or pathology is suspected, as patients may not volunteer this seemingly unrelated symptom.
In terms of the origin of Kehr sign, there is some debate about whether it was actually described by Hans Kehr, a German surgeon, or if it was named after him in error 3. However, the significance of Kehr sign as a diagnostic indicator of intra-abdominal bleeding remains unchanged, and it is an important sign that physicians should be aware of when evaluating patients with abdominal trauma or pathology. The most recent and highest quality study on this topic, published in 2023, highlights the importance of prompt diagnosis and treatment of splenic rupture, which can be life-threatening if left untreated 1.