Rovsing’s Sign

Rovsing’s sign is named after the Danish surgeon Niels Thorkild Rovsing. Rovsing’s test is considered a sign for appendicitis, elicited during examination. However, this is not done as commonly as rebound tenderness test (blumberg’s sign).

If a patient has positive rovsing’s sign, he’s suspected to have appendicitis, if other symptoms of the disease are also present.

Rovsign’s sign is not an absolute diagnostic test for appendicitis. It is just a helping tool and needs to be correlated with other signs and symptoms.

Note: Rovsing sign (an eponym of rovsign’s sign) is also used in patients suffering with horseshoe kidney. This condition presents with symptoms including nausea, abdominal pain, vomiting and hyperextension of spine.

How to elicit Rovsing’s sign

Rovsing’s sign is elicited by deep palpation of the left lower quadrant of the patient’s abdomen. This pressure in the left iliac fossa results in the pain on the right iliac fossa. This is called positive rovsing’s sign. If the pressure in left iliac fossa doesn’t cause pain in right iliac fossa, then rovsing’s sign is negative.

Make sure that you follow the proper guidelines of clinical examination for this test too, including:

• Approach the patient from right side, not left.
• Ask the patient if touching or pressing in the left iliac fossa is painful or not.
• First acclimatise the abdomen in the typical S pattern.
• Press the left iliac fossa gently but gradually, keeping your eyes on his face to see the response and any sign of pain.
• Thank the patient in the end.

Rovsing’s sign in appendicitis

Rovsing’s sign is usually checked in patients suspected with appendicitis.

Does appendicitis always result in positive rovsing’s sign?

No, appendicitis not always result in positive rovsing’s sign.

How Rovsing’s sign work

To elicit rovsing’s sign, the doctor pushes the abdomen in left iliac fossa. This is done far from appendix (assuming that most people have appendix in the right iliac fossa). This stretches the peritoneal lining all over the abdomen. However, it doesn’t cause pain else where, except the part where the inflammation causes irritation, which in this case would be appendicitis, thus in right iliac fossa.

So if the patient is suffering from appendicitis, he will feel pain in right lower quadrant of his abdomen when the pressure is applied on the left lower quadrant.

Uses of Rovsing’s sign

Rovsing’s sign can be helpful in diagnosing various disease condition. This depends upon the region in which the pain is felt as a result of pressure to left iliac fossa.

If the pain is felt in right iliac fossa, then it might be due to any inflamed tissue or organ in that region, usually appendix. However there can be any other pathology too.

If the pressure in left lower quadrant results in pain on both sides or on the left quadrant only where the pain is applied, then there might be an issue with uterus, colon, bladder, ovaries etc. However the patient might be having left sided appendix too! Therefore use this sign as a helping tool only, not a diagnostic criteria.