K-Sign in retrocaecal appendicitis: a case series

BACKGROUND Variations in position of the vermiform appendix considerably changes clinical findings. Retrocaecal appendicitis presents with slightly different clinical features from those of classical appendicitis associated with a normally sited appendix. K-sign looks for the presence of tenderness on posterior abdominal wall in the retrocaecal and paracolic appendicitis. This is the first case report of this kind in the literature. The K-sign has been named, as a mark of respect, after the region of origin of this sign, Kashmir, so called as "Kashmir Sign". The sign being present in view of inflamed appendix crossing above its non palpable position above iliac crest on the posterior abdominal wall and the tenderness is by irritation of posterior peritoneum. CASE PRESENTATION The author is reporting a case series of four patients in whom a K-sign, a clinical sign, was elicited and found positive on the posterior abdominal wall for presence of tenderness in a specific area bound by the 12th rib superiorly, spine medially, lateral margin of posterior abdominal wall laterally and iliac crest inferiorly and was found to be present in three retrocaecal and one paracolic appendicitis. Each case had tenderness in this specific area on posterior abdominal wall. All had appendectomy and having histopathological evidence of appendicitis. CONCLUSION K-sign can be useful in diagnosis of retrocaecal and paracolic appendicitis. Significance of K-sign being in view of difficulty in diagnosis of retrocaecal appendicitis and its subsequent complications.