Case Report

Pinch-an-inch Test for Appendicitis

Authors: LTC, Bruce D. Adams, MD, FACEP CAPT, Devin Rickett, MD CAPT, Philip A. Albaneze, MD CAPT, Michael D. Jones, MD MAJ, Gerald York, II, MD

Abstract

Rebound tenderness is a widely used examination technique for patients with suspected appendicitis, but it can be quite uncomfortable. An alternative test for peritonitis is termed the “pinch-an-inch” test. This report describes two patients who presented with mild abdominal pain who subsequently were found to have appendicitis. In both patients, classic peritoneal signs were absent, but the pinch-an-inch test was positive. The experienced physician's bedside clinical examination remains the most critical component for rapidly identifying peritonitis. Although rebound tenderness is a widely used examination, it is uncomfortable and may be inaccurate. To perform the pinch-an-inch test, a fold of abdominal skin over McBurney's point is grasped and elevated away from the peritoneum. The skin is allowed to recoil back briskly against the peritoneum. If the patient has increased pain when the skin fold strikes the peritoneum, the test is positive and peritonitis probably is present.


Key Points


* The experienced physician's bedside clinical examination remains the most critical component for rapidly identifying appendicitis.


* Rebound tenderness is a widely used examination, but it is uncomfortable and may be inaccurate.


* Through two case reports, a new examination technique termed “pinch-an-inch” is introduced.


* A fold of abdominal skin over McBurney's point is grasped and elevated away from the peritoneum. The skin is then allowed to recoil back briskly against the peritoneum. If the patient has increased pain when the skin fold strikes the peritoneum, the test is positive and peritonitis is presumably present.

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References

1.Wolfe JM, Henneman PL. Acute Appendicitis. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. St. Louis, Mosby, 2002, 5th ed., p 1294.
 
2.Jones RS. Acute Abdomen. In: Townsend CM, ed. Sabiston Textbook of Surgery. Philadelphia, WB Saunders, 2001, 16th ed., pp 802–814.
 
3.Matthews JB, Hodin RA. Acute Abdomen and Appendix. In: Greenfield LJ, ed. Surgery: Scientific Principles and Practice. Philadelphia, Lippincott Williams & Wilkins, 2001, 3rd ed.
 
4.Silen W. Cope's Early Diagnosis of the Acute Abdomen. Oxford, Oxford University Press, 2000, 20th ed.
 
5.Von Titte SN, McCabe CJ, Ottinger LW. Delayed appendectomy for appendicitis: causes and consequences. Am J Emerg Med 1996;14:620–622.
 
6.Cappendijk VC, Hazebroek FW. The impact of diagnostic delay on the course of acute appendicitis.Arch Dis Child 2000;83:64–66.
 
7.Lee SL, Walsh AJ, Ho HS. Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Arch Surg 2001;136:556–562.
 
8.Flum DR, Morris A, Koepsell T, et al. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA 2001;286:1748–1753.
 
9.Wagner JM, McKinney WP, Carpenter JL. Does this patient have appendicitis? JAMA1996;276:1589–1594.
 
10.Liddington MI, Thomson WH. Rebound tenderness test. Br J Surg 1991;78:795–796.
 
11.Alshehri MY, Ibrahim A, Abuaisha N, et al. Value of rebound tenderness in acute appendicitis. East Afr Med J 1995;72:504–506.
 
12.Old JL, Dusing RW, Yap W, et al. Imaging for suspected appendicitis. Am Fam Physician Jan 1 2005;71:71–78.