Rovsing's sign

Lore & Background

Niels Thorkild Rovsing was a Danish surgeon who lived from 1862 to 1927. The sign that bears his name is a maneuver used in the physical examination for suspected appendicitis. However, the phenomenon was first described by Swedish surgeon Emil Samuel Perman (1856–1945) in the journal Hygiea in 1904. Rovsing's sign is elicited by applying pressure to the left lower quadrant of the abdomen; if this causes pain in the right lower quadrant, the sign is positive and suggests appendicitis.

Reader's Guide

Rovsing's sign remains a classic component of the abdominal examination for appendicitis, though its sensitivity and specificity have not been adequately evaluated, and some consider it an antiquated test. The sign relies on the referral of pain from deep intestinal structures, which do not localize well to an exact spot on the abdominal wall. In early appendicitis, irritation may be felt near the umbilicus; with severe inflammation, the peritoneum becomes irritated, and pressure applied far from the appendix—in the left lower quadrant—can stretch the peritoneal lining and cause pain in the right lower quadrant. While a positive Rovsing's sign points to the appendix as the prime suspect, other pathology (e.g., involving the bladder, uterus, ascending colon, fallopian tubes, or ovaries) can also produce a positive result. The eponym is also used in patients with horseshoe kidney, where hyperextension of the spine causes abdominal pain, nausea, and vomiting.

Did You Know?

• Rovsing's sign is named after Danish surgeon Niels Thorkild Rovsing (1862–1927).
• A positive Rovsing's sign occurs when palpation of the left lower quadrant increases pain in the right lower quadrant.
• The eponym Rovsing sign is also used in patients with horseshoe kidney, involving abdominal pain, nausea, and vomiting with hyperextension of the spine.