McBurney’s sign is a key clinical indicator of localized peritoneal inflammation, most commonly due to acute appendicitis. It is elicited by applying pressure to McBurney’s point, located approximately 2″ (5 cm) above the anterior superior iliac spine along the line to the umbilicus. Pressure at this point produces pain and tenderness in patients with appendiceal inflammation. Before eliciting the sign, the abdomen should be inspected for distention, auscultated for bowel sounds, and palpated lightly to assess for tympany, rigidity, or guarding.

History and Physical Examination

• Ask about onset, location, and characteristics of abdominal pain.

• Inquire if coughing, movement, eating, or bowel movements worsen or relieve pain.

• Ask about associated symptoms: nausea, vomiting, low-grade fever, anorexia.

• Have the patient point to the area of maximal pain.

• Observe facial expressions for signs of pain (grimacing, wincing).

• Auscultate for hypoactive or absent bowel sounds.

• Palpate gently for tenderness, rigidity, guarding, or rebound tenderness.

Medical causes

Special Considerations

• Obtain laboratory tests: CBC (especially WBC count), ESR, blood cultures.

• Prepare for diagnostic imaging: abdominal X-rays or ultrasound.

• Nothing by mouth (NPO) until surgical evaluation.

• Avoid cathartics or enemas, which may precipitate rupture.

• Prepare for appendectomy if indicated.

Patient Counseling

• Educate on postoperative signs: increased pain, fever, redness, drainage from the wound.

• Provide guidance on wound care, hygiene, and activity restrictions.

• Advise on pain management and follow-up appointments.

Pediatric pointers

• McBurney’s sign can be elicited in children, though interpretation may be challenging due to limited cooperation.

• Monitor for systemic signs such as fever and vomiting, which are common in pediatric appendicitis.

Geriatric pointers

• In elderly patients, McBurney’s sign may be diminished or absent.

• High suspicion for appendicitis is warranted even with subtle or atypical signs.

References

1. Ilves I, Paajanen HE, Herzig KH, Fagerstrom A, Miettinen PJ. Changing incidence of acute appendicitis and nonspecific abdominal pain between 1987 and 2007 in Finland. World J Surg. 2011;35(4):731–738.

2. Wilms IM, De Hoog DE, De Visser DC, Janzing HM. Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev. 2011;9(11):CD008359.