Signs and syndromes in acute appendicitis: A pathophysiologic approach

Physical examination signs have not been well studied, and their accuracy and reliability in diagnosis remain unknown. The few studies available are limited in that the method of performing the sign was not stated, the technique used was not standardized, and the position of the appendix was not correlated with imaging or surgical findings. Some appendiceal signs were written in a non-English language and may not have been appropriately translated (e.g., Blumberg-Shchetkin and Rovsing). In other cases, the sign described differs from the original report (e.g., Rovsing, Blumberg-Shchetkin, and Cope sign, Murphy syndrome). Because of these studies limitations, gaps remain regarding the signs’ utility in the bedside diagnosis of acute appendicitis. Based on the few studies available with these limitations in mind, the results suggest that a positive test is more likely to be found in acute appendicitis. However, a negative test does not exclude the diagnosis. Hence, these tests increase the likelihood of ruling in acute appendicitis when positive but are less helpful in ruling out disease when negative. Knowledge about the correct method of performing the sign may be a valuable adjunct to the surgeon in further increasing their pretest probability of disease. Furthermore, it may allow surgeons to study these signs further to better understand their role in clinical practice. In the interim, these signs should continue to be used as a tool to supplement the clinical diagnosis.