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To the Editor:
—I have on several occasions noted a sign which appears to be of value in differentiating between acute appendicitis and simple gaseous distention of the cecum associated with acute bowel fermentation. So far as I know the sign has never been described. It is elicited as follows:Gentle pressure is brought to bear over the cecum, pressing in an upward direction. If the condition is simply gaseous distention, the patient will complain of pain in this region, but also complains of pain in left hypochondrium; pain disappears when the pressure is relieved. The explanation appears to be this: The enormous quantity of gas in the cecum is forced upward by the pressure, passing along the ascending and transverse colon, but is caught at the acute splenic flexure. The sharp impact of the gas here causes pain. This sign has on several occasions been of value to me
Salzman S. Sign for Distinguishing Gaseous Distention from Appendicitis. JAMA. 1915;LXV(15):1297. doi:10.1001/jama.1915.02580150071030