Research Article| Volume 17, ISSUE 2, P270-283, February 1945

The sensation of gas stoppage during the onset of acute appendicitis

With illustrative cases
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      • 1.
        1. A vague midline sensation of gas stoppage characterizes the onset of acute appendicitis.
      • 2.
        2. It induces the patient (a) to seek the toilet (b) to take laxatives.
      • 3.
        3. During the time of onset, a period from one to more than twenty-four hours, few patients are able to pass gas or to defecate without catharsis or enemas. Those able to pass gas or to defecate obtain little or no relief thereby. Hence, the sensation is a symptom and not a physical sign.
      • 4.
        4. This bowel consciousness is an urge downward rather than an upward urge of nausea or vomiting.
      • 5.
        5. The sensation of gas stoppage ends when pain localizes over the appendix, usually in the right iliac fossa. The features described are then altered. There is a definite pain which is different.
      • 6.
        6. The gas stoppage sensation is present at onset irrespective of whether localization later is “typical,” “atypical,” or absent.
      • 7.
        7. The sensation is particularly valuable in fulminating cases.
      • 8.
        8. Three questions have been devised to elicit it. To find it, the examiner should carefully focus the patient's mind on the time prior to localization of pain, to the time not when he first felt sick, but when he last felt perfectly well.
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        • Keyes E.L.
        Diagnostic Features of the First Pain of Acute Appendicitis.
        J. Missouri M. A. 1944; 41: 30-33
        • Richardson E.P.
        Diseases of the Appendix, Small Intestine, and Colon.
        in: Ed. 5. Surgical Diagnosis. Vol. II. W. B. Saunders Company, Philadelphia, London1930
        • Homans J.
        Textbook of Surgery. Charles C. Thomas, Publisher, Springfield, Ill., Baltimore1940
      1. Fitz, R.: Quoted by Homans.3

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        Surgery of the Appendix Vermiformis.
        in: Surgery. W. B. Saunders Company, Philadelphia and London1908