A young man with acute appendicitis has a retrocaecal appendix confirmed at operation. Which physical sign would have been most likely present preoperatively?

• A Tenderness in the rectovesical pouch on digital rectal examination
• B Pain on internal rotation of the flexed right hip
• C Pain on passive extension of the right hip ✓
• D Frequency of micturition with suprapubic pain

Explanation

The psoas sign, increased pain on passive extension of the right hip, occurs because an inflamed retrocaecal or retroperitoneal appendix lies against the psoas muscle, which is stretched by hip extension. The obturator sign, pain on internal rotation of the flexed hip, and rectal or urinary symptoms suggest a pelvic appendix lying against the obturator internus, bladder, or rectum. C retrocaecal position also explains why anterior guarding and rebound may be minimal despite severe disease.

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.