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Sherren Triangle – Clinical Sign of Appendicitis
The Sherren triangle is a clinical sign used in the diagnosis of appendicitis. It marks a triangular area of tenderness in the right lower abdomen indicating potential inflammation of the appendix.
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The Sherren triangle is a clinical sign used in the diagnosis of appendicitis. It marks a triangular area of tenderness in the right lower abdomen indicating potential inflammation of the appendix.
What is the Sherren Triangle?
The Sherren triangle is a clinically relevant sign used during physical examination of the abdomen. It describes a triangular region in the right lower abdomen that is tender to palpation in cases of appendicitis (inflammation of the appendix). The triangle is defined by three anatomical landmark points: the McBurney point, the Lanz point, and the Kümmell point. Tenderness within this triangle is considered a significant indicator of appendiceal inflammation during clinical assessment.
Anatomical Boundaries
The three corner points of the Sherren triangle are:
- McBurney Point: Located at the junction of the outer and middle third of the line connecting the right anterior superior iliac spine (ASIS) and the navel. This is the most well-known pressure pain point in appendicitis.
- Lanz Point: Located at the right third of the line connecting both anterior superior iliac spines. This point is particularly sensitive when the appendix is positioned deep within the pelvis.
- Kümmell Point: Located approximately 1–2 cm to the right of and below the navel. It is less specific but may be tender depending on the position of the appendix.
Clinical Significance
The Sherren triangle serves as a diagnostic aid during physical examination of patients with suspected appendicitis. The presence of tenderness within this triangle significantly increases the clinical likelihood of an inflamed appendix. It is a simple, non-invasive examination finding that is particularly useful in emergency medicine and general surgery.
Relationship to Other Clinical Signs
The Sherren triangle is often assessed alongside other clinical signs of appendicitis, including:
- Blumberg sign: Rebound tenderness in the right lower abdomen upon sudden release of pressure.
- Rovsing sign: Pain in the right lower abdomen when pressure is applied to the left lower abdomen.
- Psoas sign: Pain with extension of the right hip against resistance, indicating irritation of the iliopsoas muscle.
Appendicitis – Background
Appendicitis is one of the most common surgical emergencies worldwide. It results from inflammation of the vermiform appendix, a small pouch attached to the cecum. Typical symptoms include:
- Pain that begins around the navel and migrates to the right lower abdomen
- Nausea and vomiting
- Mild fever
- Loss of appetite
- Guarding or rigidity of the abdominal wall
Diagnosis
Appendicitis is primarily a clinical diagnosis, supported by laboratory findings (elevated white blood cell count, raised CRP) and imaging such as abdominal ultrasound or CT scan. Clinical scoring systems such as the Alvarado score or the Appendicitis Inflammatory Response (AIR) score combine physical examination findings -- including tenderness at the Sherren triangle landmarks -- with laboratory values to improve diagnostic accuracy.
Treatment
The standard treatment for acute appendicitis is surgical removal of the appendix (appendectomy), which is today most commonly performed minimally invasively as a laparoscopic appendectomy. In selected uncomplicated cases, conservative management with antibiotics may be considered as an alternative.
References
- Petroianu, A. (2012): Diagnosis of acute appendicitis. International Journal of Surgery, 10(3), 115–119.
- Alvarado, A. (1986): A practical score for the early diagnosis of acute appendicitis. Annals of Emergency Medicine, 15(5), 557–564.
- Standring, S. (ed.) (2020): Gray's Anatomy: The Anatomical Basis of Clinical Practice. 42nd edition. Elsevier.
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