A 30-year-old man with suspected acute appendicitis complains of pain radiating to the right groin and scrotum with micturition. On flexion and internal rotation of the right hip, he experiences increased suprapubic pain. Which anatomical position of the inflamed appendix does this examination finding indicate?

• A Retrocaecal appendix
• B Preileal appendix
• C Pelvic appendix ✓
• D Subhepatic appendix

Explanation

The obturator sign, increased suprapubic pain on passive internal rotation of the flexed hip, occurs when an inflamed pelvic appendix lies against the obturator internus muscle. A pelvic appendix also irritates the bladder and rectum, producing urinary frequency and tenesmus, matching this vignette. A retrocaecal appendix produces the psoas sign on hip extension instead, and a subhepatic appendix mimics cholecystitis.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.