Intended for healthcare professionals

Rapid response to:

Practice Easily Missed?


BMJ 2011; 343 doi: (Published 06 October 2011) Cite this as: BMJ 2011;343:d5976

Rapid Response:

Rovsing's sign

Eliciting Rovsing's sign, as classically described, is not simple
palpation of the left iliac fossa causing pain to be felt in the right
iliac fossa. Nor is it peritoneal irritation that is elicited; instead,
Rovsing's original description was an attempt to distend the caecum and
appendix by pushing on the left colon in an anti-peristaltic direction.
Studies in the 1950s on intra-operative and cadaveric manometric
measurements confirmed that the mechanism sounds as implausible now as it
did then.[1][2] The same studies found or allude to a small sensitivity
and specificity in the diagnosis of appendicitis.

More recently, a 2005 paper states a sensitivity of 30.1% and
specificity of 84.4%,[3] but given the widespread ignorance of the
original sign as described by Rovsing's, this is best regarded as a
Rovsing's-like sign and is probably, at best, merely a surrogate of
peritoneal irritation, of any cause, centred in the right iliac fossa but
extending into the left iliac fossa.

[1] Davey WW. Rovsing's sign. British medical journal. 1956 Jul 7;

[2] Yasui H. Rovsing's sign. British medical journal. 1958 May 17;

[3] Kharbanda AB, Taylor GA, Fishman SJ, Bachur RG. A clinical
decision rule to identify children at low risk for appendicitis.
Pediatrics. 2005 Sep; 116(3):709-16

Competing interests: No competing interests

17 October 2011
Mark Ong
Histopathology Registrar