McBurney’s point

McBurney’s point is the name given to the point over the right lower quadrant of the human abdomen that is one-third of the distance from the anterior superior iliac spine (ASIS) to the umbilicus ¹. McBurney’s point which is located two-thirds down an imaginary line from the umbilicus to the anterior superior iliac spine. McBurney’s point is roughly corresponds to the most common location of the base of the appendix where it is attached to the cecum. The anterior cutaneous branch of iliohypogastric nerve is found near McBurney’s point ². McBurney’s point tenderness implies possible appendicitis, inflammation of the ileocolic area such as Crohn disease or infectious etiology with bacteria that have a predilection for the ileocecal area such as Bacillus cereus and Yersinia enterocolitica ³.

For patients with an atypical position of the appendix, such as retrocecal or deep pelvic, pressure in this location may not elicit the typical exam findings. In the case of a retrocecal appendix the pain may be localized over the right flank, elicited by an extension of the hip (psoas sign), or may not be well localized on physical exam at all. An obturator sign may be present with appendicitis located in the deep pelvis. A Rosving sign consists of pain in the right lower quadrant with palpation in the left lower quadrant. Jostling the bed or striking the heel of the extended right leg can lead to right lower quadrant pain. Similarly the patient may be asked to bounce or attempt to jump, producing pain in the area. Although these findings are typical for an uncomplicated appendicitis, perforation can lead to a more generalized peritonitis, with involuntary diffuse guarding, high fever, and hemodynamic changes.

An abdominal mass on physical exam is rarely present and, when present, may be difficult to appreciate due to discomfort with deep palpation and increased abdominal wall thickness. The presence of a mass is suggestive of an abscess or phlegmon, reflecting a rupture of the appendix with adherence of omentum and surrounding bowel to the inflamed appendix. After patients are adequately treated with pain medication or when asleep after initiation of anesthesia, a mass can sometimes be palpated in children or thin patients.

References

1. Shackelford’s Surgery of the Alimentary Tract, 2 Volume Set 8th Edition 2019. ISBN 978-0-323-40232-3 https://doi.org/10.1016/C2015-1-00854-7
2. Naraynsingh V, Ramdass MJ, Singh J, Singh-Rampaul R, Maharaj D (2003). “McBurney’s point: are we missing it?”. Surgical and radiologic anatomy : SRA. 24 (6): 363–5. doi:10.1007/s00276-002-0069-7
3. Mealie CA, Manthey DE. Abdominal Exam. [Updated 2019 Jul 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459220