How is appendicitis diagnosed in patients lacking a classic clinical presentation?

Updated: Jul 23, 2018
  • Author: Sandy Craig, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Patients with appendicitis may not have the reported classic clinical picture 37-45% of the time, especially when the appendix is located in an unusual place (see Anatomy). In such cases, imaging studies may be important but not always available. However, patients with appendicitis usually have accessory signs that may be helpful for diagnosis (see Physical Examination). For example, the obturator sign is present when the internal rotation of the thigh elicits pain (ie, pelvic appendicitis), and the psoas sign is present when the extension of the right thigh elicits pain (ie, retroperitoneal or retrocecal appendicitis).

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