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Sitkowski Sign – Clinical Sign in Appendicitis

The Sitkowski sign is a clinical examination finding used when appendicitis is suspected. It is positive when the patient experiences right lower quadrant pain upon being turned to the left side.

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The Sitkowski sign is a clinical examination finding used when appendicitis is suspected. It is positive when the patient experiences right lower quadrant pain upon being turned to the left side.

What Is the Sitkowski Sign?

The Sitkowski sign is a clinical examination finding used in the physical assessment of patients with suspected appendicitis (inflammation of the appendix). It is named after the Polish surgeon Wincenty Sitkowski, who described it in the early 20th century.

The sign is considered positive when the patient experiences pain in the right lower quadrant of the abdomen upon being repositioned onto their left side. This pain is thought to result from traction and mechanical displacement of the inflamed appendix caused by the change in body position.

Clinical Relevance

The Sitkowski sign is one of several clinical signs used together to support or reduce the suspicion of appendicitis. It is typically assessed alongside other well-known clinical signs, including:

McBurney sign: Point tenderness at the McBurney point (one-third of the way from the right anterior superior iliac spine to the umbilicus)
Blumberg sign: Rebound tenderness in the right lower quadrant
Rovsing sign: Right lower quadrant pain elicited by palpating the left lower quadrant
Psoas sign: Right lower quadrant pain on extension of the right hip

No single clinical sign is sufficient on its own to confirm or rule out appendicitis. The combination of multiple positive signs significantly increases diagnostic accuracy.

Pathophysiological Background

In appendicitis, the vermiform appendix becomes inflamed, swollen, and tender. When the patient rolls onto the left side, the abdominal organs shift slightly, causing mechanical movement or traction on the inflamed appendix. This produces the characteristic right lower quadrant pain that defines a positive Sitkowski sign. The sign is therefore classified as a positional traction sign in the clinical evaluation of appendicitis.

How the Examination Is Performed

The test is simple and requires no equipment:

The patient begins by lying in the supine position (flat on the back).
The examiner asks the patient to roll onto their left side.
If the patient reports new or worsening pain in the right lower abdomen during or after this maneuver, the Sitkowski sign is considered positive.
If no pain occurs, the sign is negative.

The test is non-invasive and can be performed at the bedside without any technical equipment.

Diagnostic Value

Like other individual clinical signs for appendicitis, the Sitkowski sign has limited sensitivity and specificity when used alone. It must always be interpreted in the context of the overall clinical picture, patient history, and additional diagnostic measures, such as:

Blood tests (white blood cell count, CRP as markers of inflammation)
Abdominal ultrasound
CT scan of the abdomen in unclear cases
Clinical scoring systems such as the Alvarado score

A combination of multiple positive clinical signs along with elevated inflammatory markers in the blood increases suspicion of appendicitis and may support the decision for surgical intervention (appendectomy).

References

Petroianu, A. - Diagnosis of acute appendicitis. In: International Journal of Surgery, 2012.
Wagner, J.M., McKinney, W.P., Carpenter, J.L. - Does this patient have appendicitis? JAMA, 1996;276(19):1589-1594.
Schwartz's Principles of Surgery, 11th Edition, McGraw-Hill Education, 2019.

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