Rovsing’s Sign

What Is It, Procedure, Associated Appendicitis, and More

Author:Lily Guo

Editors:Ian Mannarino, MD, MBA,Ahaana Singh

Illustrator:Jillian Dunbar

What is Rovsing’s sign?

Rovsing’s sign is a clinical finding that is indicative of acute appendicitis (the inflammation and possible infection of the appendix). A positive Rovsing’s sign is characterized by right lower abdominal pain upon palpation of the left side of the lower abdomen. This finding was named after Niels Thorkild Rovsing, a Danish surgeon, in 1907.

How do you perform Rovsing’s sign?

Rovsing’s sign is performed on an individual lying flat on their back, usually on an examination table. A clinician will press slowly and gently into the left lower quadrant of the individual’s abdomen, and then gradually release pressure. If the individual feels sudden pain in the right lower quadrant of the abdomen, it is indicative of a positive Rovsing’s sign.

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Is Rovsing’s sign the same as rebound tenderness?

Rebound tenderness, also known as Blumberg’s sign, refers to the presence of pain when pressure is removed from the abdomen, rather than when applied. Although rebound tenderness can be elicited when performing Rovsing’s sign, it is not the same thing. Rebound tenderness is often indicative of general peritonitis or inflammation of the peritoneum, the membrane that lines the inner abdominal wall and covers the abdominal organs. Notably, however, the inflammation caused by appendicitis can lead to subsequent infection and peritoneal irritation which presents with rebound tenderness upon palpation.

What causes Rovsing’s sign?

A positive Rovsing’s sign is the result of acute appendicitis, characterized by the inflammation, infection, or swelling of the appendix. The appendix is a narrow, finger-shaped pouch that projects out from the cecum, or the beginning of the large intestine. Generally, appendicitis can be caused by blockage in the appendix, infection of the gastrointestinal tract, or trauma to the abdomen. 

Since its discovery, there have been several hypotheses for the exact mechanism causing the pain associated with Rovsing’s sign. Primarily, it is believed that the pressure from the maneuver generates elevated tension in the abdomen near the appendix. This manual pressure, along with the accumulation of intestinal gases in the colon and resistance at the ileocecal valve (connecting the large and small intestine), results in pain in the lower right quadrant. Alternatively, the pain could also be a result of the inflamed appendix rubbing against the right iliac fossa, a surface of the hip bone, as a result of rightward movement of the small intestine. Lastly, the pain elicited by Rovsing’s sign may be due to the manual pressure on the peritoneum, producing friction against the inflamed appendix.

How do you treat conditions associated with Rovsing’s sign?

Rovsing’s sign is useful in the diagnosis of acute appendicitis. Acute appendicitis is considered a medical emergency and requires prompt medical attention. If left untreated, the appendix can potentially rupture, spreading bacteria throughout the abdominal cavity and creating a potentially life-threatening situation. 

The standard of procedure for an unruptured appendicitis is an appendectomy, or the surgical removal of the appendix. An appendectomy can be performed by laparotomy, creating one larger incision through the abdominal wall; or by laparoscopy, creating a few smaller incisions with the aid of a camera and laparoscopic instruments.

What are the most important facts to know about Rovsing’s sign?

Rovsing’s sign refers to the pain felt in the right lower abdomen upon palpation of the left side of the abdomen. A positive Rovsing’s sign is indicative of acute appendicitis, characterized by inflammation, infection, or swelling of the appendix. Unlike Rovsing’s sign which is typically used for diagnosing appendicitis, rebound tenderness is seen in various conditions that cause a condition called peritonitis (inflammation of the peritoneum). To overcome Rovsing’s sign, treatment of the underlying appendicitis is required. This is usually accomplished through an appendectomy, a specific type surgery to remove the inflamed appendix.

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Related links

Clinical Reasoning: Abdominal pain
Clinical Reasoning: Appendicitis
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High Yield: Appendicitis

Resources for research and reference

Rastogi, V., Singh, D., Tekiner, H., Ye, F., Kirchenko, N., Mazza, J. J., & Yale, S. H. (2018). Abdominal Physical Signs and Medical Eponyms: Physical Examination of Palpation Part 1, 1876-1907. Clinical Medicine & Research, 16(3-4): 83–91. DOI: 10.3121/cmr.2018.1423