McBurney's point
Encyclopedia
McBurney's point is the name given to the point over the right side of the abdomen
that is one-third of the distance from the anterior superior iliac spine
to the navel
. This point roughly corresponds to the most common location of the base of the appendix
where it is attached to the cecum
.
Deep tenderness at McBurney's point, known as McBurney's sign, is a sign of acute appendicitis.
The clinical sign of referred pain in the epigastrium
when pressure is applied is also known as Aaron's sign. Specific localization of tenderness to McBurney's point indicates that inflammation is no longer limited to the lumen of the bowel (which localizes pain poorly), and is irritating the lining of the peritoneum
at the place where the peritoneum comes into contact with the appendix. Tenderness at McBurney's point suggests the evolution of acute appendicitis to a later stage, and thus, the increased likelihood of rupture. Other abdominal processes can also sometimes cause tenderness at McBurney's point. Thus, this sign is highly useful but neither necessary nor sufficient to make a diagnosis of acute appendicitis. Also, the anatomical position of the appendix is highly variable (for example in retrocaecal appendix, an appendix behind the caecum), which also limits the use of this sign as many cases of appendicitis do not cause point tenderness at McBurney's point. For most open appendectomies (as opposed to laparoscopic appendectomies), the incision is made at McBurney's point.
, U.S. surgeon, 1845–1913.
As a matter of fact McBurney himself did not locate "his" point in such a precise way in his original article.
Experience with early operative interference in cases of disease of the vermiform appendix.
New York Medical Journal, 1889, 50: 676-684. Page 678:
The seat of greatest pain, determined by the pressure of one finger, has been very exactly between an inch and a half and two inches from the anterior spinous process of the ilium on a straight line drawn from that process to the umbilicus.
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
that is one-third of the distance from the anterior superior iliac spine
Anterior superior iliac spine
The anterior superior iliac spine is an important landmark of surface anatomy. It refers to the anterior extremity of the iliac crest of the pelvis, which provides attachment for the inguinal ligament, and the sartorius muscle...
to the navel
Navel
The navel is a scar on the abdomen caused when the umbilical cord is removed from a newborn baby...
. This point roughly corresponds to the most common location of the base of the appendix
Vermiform appendix
The appendix is a blind-ended tube connected to the cecum , from which it develops embryologically. The cecum is a pouchlike structure of the colon...
where it is attached to the cecum
Cecum
The cecum or caecum is a pouch, connecting the ileum with the ascending colon of the large intestine. It is separated from the ileum by the ileocecal valve or Bauhin's valve, and is considered to be the beginning of the large intestine. It is also separated from the colon by the cecocolic...
.
Clinical relevance
The clinical sign of referred pain in the epigastrium
Epigastrium
The epigastrium is the upper central region of the abdomen. It is located between the costal margins and the subcostal plane....
when pressure is applied is also known as Aaron's sign. Specific localization of tenderness to McBurney's point indicates that inflammation is no longer limited to the lumen of the bowel (which localizes pain poorly), and is irritating the lining of the peritoneum
Peritoneum
The peritoneum is the serous membrane that forms the lining of the abdominal cavity or the coelom — it covers most of the intra-abdominal organs — in amniotes and some invertebrates...
at the place where the peritoneum comes into contact with the appendix. Tenderness at McBurney's point suggests the evolution of acute appendicitis to a later stage, and thus, the increased likelihood of rupture. Other abdominal processes can also sometimes cause tenderness at McBurney's point. Thus, this sign is highly useful but neither necessary nor sufficient to make a diagnosis of acute appendicitis. Also, the anatomical position of the appendix is highly variable (for example in retrocaecal appendix, an appendix behind the caecum), which also limits the use of this sign as many cases of appendicitis do not cause point tenderness at McBurney's point. For most open appendectomies (as opposed to laparoscopic appendectomies), the incision is made at McBurney's point.
Eponym
The sign is named for Charles McBurney (surgeon)Charles McBurney (surgeon)
Charles Heber McBurney, MD was an American surgeon known for describing McBurney's point in appendicitis.-Biography:Charles McBurney was born in 1845...
, U.S. surgeon, 1845–1913.
As a matter of fact McBurney himself did not locate "his" point in such a precise way in his original article.
Experience with early operative interference in cases of disease of the vermiform appendix.
New York Medical Journal, 1889, 50: 676-684. Page 678:
The seat of greatest pain, determined by the pressure of one finger, has been very exactly between an inch and a half and two inches from the anterior spinous process of the ilium on a straight line drawn from that process to the umbilicus.