A 30-year-old man has two days of poorly localized low back and flank discomfort, minimal nausea, and slight fever. He has no tenderness in the right iliac fossa, but passive extension of the right hip reproduces severe pain. Where is the appendix most likely located?

• A Retrocecal, lying against the iliacus muscle ✓
• B Pelvic, adjacent to the bladder
• C Preileal, anterior to the terminal ileum
• D Subhepatic, under the liver edge

Explanation

A retrocecal appendix lies against the iliacus and psoas muscles, so hip extension stretches these muscles and reproduces pain, giving a positive psoas sign. Because the inflamed appendix is shielded by the cecum, right iliac fossa guarding and tenderness are often absent or mild, and pain may localize to the loin or back. A pelvic appendix instead produces urinary frequency and diarrhea, and is detected by rectal tenderness rather than the psoas sign.

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.