Intended for healthcare professionals

Letters Response

Kenneth Taylor responds to Des Spence

BMJ 2011; 342 doi: (Published 28 June 2011) Cite this as: BMJ 2011;342:d3957
  1. Kenneth G Taylor, consultant physician1
  1. 1Birmingham, UK
  1. kandgtaylor{at}

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 …

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