[Physical examination of patients with acute abdominal pain].

Reliable physical examination of patients presenting with acute abdominal pain and tenderness is necessary for identifying serious causes on the one hand, and for preventing further unnecessary imaging on the other. If acute appendicitis or peritonitis is suspected, positive palpatory findings like rigidity and guarding are helpful diagnostic indicators, whereas negative palpatory findings have little value in excluding these conditions. Physical examination is of limited predictive value in diagnosing cholecystitis. Visible peristalsis strongly argues for small bowel obstruction, but this sign is rarely present. Digital rectal examination appears to have no added diagnostic value for appendicitis, peritonitis, or small bowel obstruction.