Rovsing Sign: What is it? History, Uses, Pathologies and Procedure

It is a sign used mostly to detect diseases such as appendicitis.

If the palpation of the left lower quadrant of a person’s abdomen increases, the pain is felt in the right lower quadrant, the patient is said to have a positive Rovsing sign and may have appendicitis.

The sign of Rovsing, named after the Danish surgeon Niels Thorkild Rovsing (1862-1927) who is remembered for describing this sign for the first time, his work included abdominal pathologies, including cystitis , urinary tract tuberculosis, gallstone disease and appendicitis.

In acute appendicitis , palpation in the left iliac fossa can produce pain in the right iliac fossa.


The sign of Rovsing, as it is classically described, is not a simple palpation of the left iliac fossa that causes pain in the right iliac fossa, in order to determine certain conditions.

Neither is peritoneal irritation what is provoked; instead, Rovsing’s original description was an attempt to distend the appendix by pressing the left colon in an antiperistaltic direction.

Studies in the 1950s on intraoperative manometry and cadaveric measurements confirmed that the mechanism sounds as implausible now as it did then.

The same studies found a small sensitivity and specificity in the diagnosis of appendicitis, thanks to this the function that is currently given to the Rovsing sign was generated.

More recently, a 2005 document indicates a sensitivity of 30.1% and specificity of 84.4%, but given the generalized ignorance of the original sign as described by Rovsing, this is better considered as “The similar sign of Rovsing” .

It is probably, in the best case, simply a substitute for peritoneal irritation, of any cause centered in the right iliac fossa but extending into the left iliac fossa.

Uses of the Rovsing sign

The Rovsing sign can be useful in diagnosing various diseases, depending on the region in which the pain is felt as a result of pressure in the left iliac fossa.

If the pain is felt in the right iliac fossa, it may be due to any inflamed tissue or organ in that region, usually appendix, however, there may also be another pathology.

If the pressure in the lower left quadrant causes pain on both sides or in the left quadrant only where the pain is applied, there may be a problem with the uterus, colon, bladder, ovaries, etc.

However, it is possible that the patient has an appendix on the left side as well.

Therefore, use this sign as a help tool only, not as a diagnostic criterion.


This anomaly occurs because the nerves of deep pain in the intestines are not located well in an exact point of the abdominal wall, unlike the pain nerves in the muscles.

The pain of an ulcer or gallstones can be interpreted by the brain as pain in the stomach, liver, gallbladder, duodenum or the first part of the small intestine.

Pain will often be referred to the upper half of the abdomen.

Because the appendix is ​​a portion of the intestine, it follows a similar derivation pattern.

An appendix with some early inflammation can cause nonspecific irritation near the navel.

If the inflammation becomes severe, it can irritate the inner lining of the abdominal cavity called the peritoneum.

This thin layer is located under or behind the muscles of the abdominal wall. Now the pain is “localized”.

If pressure is applied to the muscles of the right lower abdomen (or iliac fossa) near a very irritated appendix, then the muscle fibers in that area will stretch and hurt.


The Rovsing sign is obtained by pressing the abdomen away from the appendix in the left lower quadrant since in most people the appendix is ​​in the lower right quadrant.

While this maneuver stretches the entire peritoneal lining, it only causes pain anywhere the peritoneum irritates the muscle.

In the case of appendicitis, pain is felt in the right lower quadrant despite the pressure that is placed elsewhere.

Most professionals press on the lower left quadrant to see where the patient complains of pain.

If you feel pain in the right lower quadrant, there may be an inflamed organ or a piece of tissue in the right lower quadrant.

The appendix is ​​usually the main suspect, although another pathology can also give a “positive” Rovsing sign.

If the lower left quadrant pressure on the examiner’s side only leads to pain on the left side or pain on the left and right sides, then there may be some other pathological etiology.

This may include causes related to the bladder, uterus, ascending colon (right), fallopian tubes, ovaries, or other structures.

The eponymous sign Rovsing is also used in patients with kidney stones , which presents symptoms such as abdominal pain , nausea and vomiting with hyperextension of the spine.

While the Rovsing test is frequently performed on suspicion of appendicitis, its sensitivity and specificity have not been adequately evaluated, and some consider it an outdated examination test.