Kenneth Taylor responds to Des Spence

The time and place for digital rectal examination in the full assessment of a patient are all important.1

I recall the case of a middle aged person who collapsed in the street. There was no significant history, and the main finding on examination was a significant postural drop in blood pressure. Rectal examination showed melaena, and, after resuscitation, the patient was found to have a bleeding duodenal ulcer. Not a useless examination in this case.

What about a patient with an acute abdomen with suspected acute appendicitis in whom acute tenderness is shown on rectal examination owing to a pelvic appendix? Is it a useless …