A 28-year-old man has right iliac fossa pain for 18 hours. Anterior abdominal wall tenderness and guarding are minimal, but he experiences severe pain when the right hip is passively extended with the knee extended. This finding suggests which anatomical position of the inflamed appendix?

• A Pelvic, lying against the obturator internus
• B Retrocaecal, lying against the iliopsoas muscle ✓
• C Subcecal, lying against the femoral nerve
• D Preileal, lying free against the parietal peritoneum

Explanation

Pain on passive extension of the hip is the psoas sign, produced when an inflamed retrocaecal appendix lying on the psoas major is stretched by contraction or stretch of that muscle. A pelvic appendix produces the obturator sign, pain on internal rotation of the flexed hip, which is option A. Subcecal and preileal positions do not classically produce either sign, and the femoral nerve lies on the iliacus rather than producing this classical test.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.