Rebound tenderness overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Rebound tenderness is one of the most important signs of peritonitis when evaluating an acute abdomen. In recent years the value of rebound tenderness has been questioned, since it may not add any diagnostic value beyond the observation that the patient has severe tenderness.

Rebound tenderness is thought to be due to stretching of the peritoneum.

Children, the immunocompromised, and the elderly are less likely to show peritoneal signs and may have atypical presentations.

Rebound tenderness is a clinical sign that a doctor may detect in physical examination of a patient’s abdomen. It refers to pain upon removal of pressure rather than application of pressure to the abdomen. (The latter is referred to simply as abdominal tenderness.) To elicit the sign, gentle pressure is placed on the abdomen and then the hand is lifted suddenly. A sudden increase in abdominal pain occurs when the examiner’s hand is lifted. The other physical examination findings to distinguish rebound tenderness are abdominal tenderness and guarding.

Blood volume should be immediately replaced with saline and/or blood transfusion for those patients that are hemodynamically unstable and bowel rest for diverticulitis or bowel obstruction (possible colon resection).

Indications for surgery when elicited would be as a result of life threatening emergencies such as; early sepsis or evidence of hemorrhage, which would require immediate surgical intervention, ruptured aneurysm, ectopic pregnancy, bowel perforation or other pathologies require definite surgical repair.

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