General Surgery
Right Lower Quadrant Pain in a Young Adult
Presentation
A 22-year-old man presents with 18 hours of abdominal pain that began periumbilically and later migrated to the right lower quadrant. He reports nausea, one episode of vomiting, and anorexia, and says the pain worsens with movement and the car ride to the ER.
T 38.1 C, HR 98, BP 124/78, RR 16, SpO2 99% on room air
On exam he has maximal tenderness at McBurney point with voluntary guarding and a positive Rovsing sign. Which finding most specifically supports acute appendicitis in this presentation?