As Hertzler has remarked, it seems strange that a viscus capable of such a wide range of locality as the appendix will, when inflamed, always have a point of greatest tenderness over the so-called McBurney's point, about midway between the right anterior superior spinous process of the ilium and the navel. He says the answer is that it does not. While the normally placed appendix gives pain at this point, the appendix abnormally situated shows maximum pain and tenderness elsewhere.
The symptoms of a typical uncomplicated case of acute appendicitis permit little diagnostic doubt. The rather sudden pain beginning in the epigastrium or around the navel, and the general abdominal discomfort with pain and muscle spasm eventually settling in the right iliac fossa, are almost pathognomonic of appendicitis. The sequence of the pain in the epigastrium or around the navel and later in the right iliac fossa is important. These
HORSLEY JS. UNPERFORATED ULCERS OF TERMINAL ILEUM, SYMPTOMATICALLY SIMULATING APPENDICITIS. JAMA. 1925;85(12):863–867. doi:10.1001/jama.1925.02670120001001
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