Last reviewed 01/2018

Possible signs include:

  • lying still, with shallow breaths and reluctant to cough
  • tachycardia
  • fever 37.5-38.5øC, worsening with perforation
  • foetor oris - halitosis
  • furred tongue
  • flushed
  • right iliac fossa signs:
    • tenderness:
      • dependent on position of viscus; localised tenderness per se is a more valuable sign than tenderness localised over McBurney's point
      • not evident before later inflammation of serosa and parietal peritoneum
      • often masked in obese due to inability to displace viscus
    • rigidity:
    • after the development of localised tenderness
      • localised initially progressing to generalised with perforation or increasing peritonitis
    • guarding
  • rebound tenderness
    • tender on the right per rectum
  • a mass in the right iliac fossa is suggestive of abscess formation
  • positive Rovsing's sign
  • with retrocaecal appendicitis, possible positive:
    • psoas sign
    • obturator sign
  • paraesthesia:
    • occasionally reported in the distribution of T10-T12 on the right side
    • test with light scratch with a sterile needle


  • a systematic review revealed that the most useful single feature for diagnosing appendicitis in children with abdominal pain was fever in unselected children and rebound tenderness in selected children (1)