BLUMBERG SIGN: HISTORY, CONSIDERATIONS, DISEASES - MEDICINE - 2025

The rebound tenderness, also known as rebound sign, is the response of a patient with abdominal pain to a maneuver by the physician on physical examination. This maneuver consists of applying pressure to any point of the abdomen with the hand and rapidly decompressing. The sign is positive if the patient has pain with sudden abdominal decompression.

Blumberg's sign is one of the best known and used at the time of physical examination of the patient with abdominal pain. It is easy to learn, requires no specialized techniques or equipment, and guides the physician toward the diagnosis of acute abdomen.

By US Navy photo by Mass Communication Specialist 2nd Class Joshua Valcarcel - This Image was released by the United States Navy with the ID 090715-N-9689V-008 (next). This tag does not indicate the copyright status of the attached work. A normal copyright tag is still required. See Commons: Licensing. বাংলা - Deutsch - English - español - euskara - فارسی - français - italiano - 日本語 - 한국어 - македонски - മലയാളം - Plattdüütsch - Nederlands - polski - پښتو - português - svenska - Türkçe - укра （нсe - укра （нс简体） - +/−, Public Domain, The term acute abdomen refers to a severe pain condition that denotes serious disease, usually infectious, of an intra-abdominal organ. In the vast majority of cases of acute abdomen, treatment is surgical.

History

The Blumberg sign was described by Dr. Jacob Moritz Blumberg, a native Prussian (present-day Germany) surgeon and gynecologist graduated from the University of Wroclaw in 1897.

The palpation maneuver in patients with acute abdominal pain was described in his article A new diagnostic symptom in appendicitis, published in 1907. It is associated with inflammation of the peritoneum, which is the sheet that covers the abdominal cavity and makes it possible your mobility.

Description of the sign

In the 1907 publication, Dr. Blumberg explains that to perform the maneuver the patient must lie on his back. In this position, the doctor should press his hand on the section of the abdomen to be examined.

While exerting this pressure, you should observe the patient's face and ask about the intensity of pain they feel.

Subsequently, the doctor should quickly remove the hand that was applying pressure and ask the patient about the degree of pain they feel when making this movement. The sign is considered positive when the patient changes his facial expression to one of pain and reports more pain with decompression than with pressure exerted on the abdomen.

By Internet Archive Book Images - https://www.flickr.com/photos/internetarchivebookimages/14597558680/Source book page: https://archive.org/stream/clevelandmedical1518unse/clevelandmedical1518unse#page/n490/mode/1up, No restrictions, The Blumberg sign is based on bouncing the two layers of peritoneum between them and thus causing pain in the patient suffering from an infectious process of the abdomen.

The peritoneum is a layer that lines the organs of the abdominal cavity. It consists of two layers that under normal conditions are in direct contact.

When there is an infectious process in the abdomen, such as the inflammation of the vermiform appendix for example, the peritoneum becomes inflamed and fluid forms between the layers that make it up. This causes a small space to be created between them and they slide and bounce when performing this type of maneuver.

Clinical considerations

With the maneuver to the physical examination described by Dr. Blumberg, which triggers abdominal pain when the hand that exerts pressure on the abdomen is suddenly withdrawn, the aim is to bounce both peritoneal layers together.

By OpenStax College - Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 3.0, With the inflammation that the peritoneum presents due to intra-abdominal infection, this rebound causes severe pain to the patient, generating several responses. One is the so-called algid fascies, which is nothing but the change of expression. That is, a patient with a normal expression adopts one of pain immediately.

Another response for the sudden and strong pain is the momentary interruption of breathing and also speech, in case you are answering any question from the examiner.

This maneuver is also used in cases in which it is suspected that the patient is faking abdominal pain since the sign of peritoneal irritation is very difficult to fake. In addition to presenting with other clinical manifestations such as increased tone of the abdominal muscles, which is known as muscular defense.

Associated diseases

Blumberg's sign is a painful response that results in an intra-abdominal infectious process.

This process can range from appendicitis that is beginning its inflammatory process, to the perforation or rupture of an intra-abdominal organ.

Acute appendicitis

Acute appendicitis is the most common cause of an acute abdomen in young patients. This is the inflammation of the vermiform appendix, which is an organ located in the ascending portion of the large intestine known as the cecum.

The appendix is ​​a hollow organ, ending in a sac. The lumen has a small diameter and any element that obstructs it can begin its inflammatory process ending in acute appendicitis.

There are many causes that trigger appendicitis. One of the most frequent is the impaction of a small piece of feces, known as fecalito. The fecalith completely obstructs the lumen of the appendix, allowing bacteria from the normal intestinal flora to proliferate, which end up contaminating the abdominal cavity.

Blumberg's sign is frequently associated with the clinical diagnosis of acute appendicitis. In fact, it is part of some of the predictive systems of appendicitis, such as the Alvarado scale, giving great weight to its presence in the patient with abdominal pain.

Acute cholecystitis

Acute cholecystitis is one of the most frequent causes of abdominal pain, especially in women.

It is the acute inflammation of the gallbladder, which is an organ located under the liver that serves as a reservoir for a digestive fluid of fats called bile and which is a frequent place of stone formation.

By BruceBlaus - Own work, CC BY-SA 4.0, When the gallbladder has stones inside it causes severe cramping pain called biliary colic. However, if bacteria begin to proliferate inside it, a true inflammatory process can be triggered that can even lead to the perforation of this organ.

When the patient is evaluated as a whole, taking into account the history, symptoms, evolution and physical examination, the presence of the Blumberg sign guides the doctor towards worsening of the cholecystitis, indicating that there may be small perforations in the wall of the gallbladder and that the patient should be operated urgently.

Surgical importance

When Blumberg's sign is present in a patient with abdominal pain, the treating physician should be vigilant and proceed to surgical treatment.

This is because the Blumberg sign indicates peritoneal irritation, that is, an infectious inflammatory process has begun in the abdominal cavity that has spread throughout the peritoneum and that can bring serious complications for the patient, even death.

References

1. Alvarado, A. (2016). How to improve the clinical diagnosis of acute appendicitis in resource limited settings. World journal of emergency surgery. Taken from: ncbi.nlm.nih.gov
2. Rastogi, V; Singh, D; Tekiner, H; Ye, F; Mazza, J. J; Yale, SH (2019). Abdominal Physical Signs and Medical Eponyms: Part II. Physical Examination of Palpation, 1907-1926. Clinical medicine & research. Taken from: ncbi.nlm.nih.gov
3. Golledge, J., Toms, AP, Franklin, IJ, Scriven, MW, & Galland, RB (1996). Assessment of peritonism in appendicitis. Annals of the Royal College of Surgeons of England. Taken from: ncbi.nlm.nih.gov
4. Humes, D. J; Simpson, J. (2006). Acute appendicitis. BMJ (Clinical research ed.) Taken from: ncbi.nlm.nih.gov
5. Ohle, R., O'Reilly, F., O'Brien, KK, Fahey, T., & Dimitrov, BD (2011). The Alvarado score for predicting acute appendicitis: a systematic review. BMC medicine. Taken from: bmcmedicine.biomedcentral.com