Rectal exam for appendicitis

Had my appendix out at age 5 in the late 90s, was taken to the ER late one night crying in pain, dad thought it was gas cramps and it probably would've ruptured if my mom hadn't taken me in. I got a CT scan and was cut open. Nothing got put in my ass. If they had given me a rectal exam, I imagine they'd still have given me a CT scan before cutting a small child open, especially since even though technology was advancing, appendectomies still involved properly slicing you open, instead of the current keyhole surgery they do.

Yes I had a rectal, 2 actually before my surgery. But this was 1977 I think, maybe it was 78, long before MRIs

@Nurse_Phillips I'm unsure MRIs are done often to diagnose appendicitis due to costs. I think the method was ultrasound. But anyway it happened after us both had our appendix removed.

My best friend in high school went to the ER to tile out appendicitis. She told me afterward she was given a rectal exam.

Ultrasound (pediatrics) and CT scan (adults) are the preferred way of identifying appendicitis. I can't say I had a rectal exam when being assessed for appendicitis; I feel this is both an unnecessary and mildly hazardous addition that wouldn't yield much extra info, but maybe back in the day it was considered “higher yield”.

Ultrasound (pediatrics) and CT scan (adults) are the preferred way of identifying appendicitis. I can't say I had a rectal exam when being assessed for appendicitis; I feel this is both an unnecessary and mildly hazardous addition that wouldn't yield much extra info, but maybe back in the day it was considered “higher yield”

back in the day CT and Ultrasound didn’t exist

I didn't think you could reach the appendix thru the rectum.

Never heard of that, first time hearing it.

back in the day CT and Ultrasound didn’t exist

The CAT (Computed Axial Tomography) scan was invented in the early 1970’s and initially used for brain scans. Data was collected on mag tape and processed at an off-site facility. Not very timely! Now called a Computed Tomography (CT) scan, it was quite a few years later before they could speed up the scans to eliminate patient motion and compute results on site.

Ultrasound imaging was invented in the 1950's, but wasn't cost effective until sometime in the 1970's. Sometime after that it became the gold standard for fetal imaging etc.

My wife had appendicitis around 1992 and I assume (just guessing) they used a CT scan to diagnose.

@Rigel When I was a kid CT scans were cumbersome affairs and I think mostly reserved for serious issues such as cancer.

@Rigel forgive me. They ‘existed’ but in 1977 your average hospital didn't have one and their resolution wasn't what it was to become. MY POINT is that ‘back in the day’ meaning the 70's, they weren't available as a diagnostic tool - which caused many false positives - like mine. My appendix wasn't inflamed when they went in.

Never heard of that, first time hearing it.

Never heard of what?

Jebus people, if you don't know something do a little research before you make pronouncements

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557952/

EDIT

The key, above, is DRE is a traditional diagnostic tool for appendicitis but it needs to be re-evaluated in light of more accurate modern diagnostic tools.

So those of you saying it never happened are wrong but you ARE right that it's a much less effective tool given the alternatives that now exist.

@Nurse_Phillips

@Rigel forgive me. They ‘existed’ but in 1977 your average hospital didn't have one and their resolution wasn't what it was to become. MY POINT is that ‘back in the day’ meaning the 70's, they weren't available as a diagnostic tool - which caused many false positives - like mine. My appendix wasn't inflamed when they went in.

You’re right, even though they were ”invented” - they weren’t available as tools Back in the 70’s. Wasn’t contradicting you, rather I was agreeing with you. Too bad they had to open you to find out your appendics wasn’t inflamed. Did they remove it anyway as a precaution since they were in there already? My wife had laparoscopic to remove hers, and even that resulted in a painful recovery.

I had my appendix out when I was around 10. I definitely would have remembered if someone stuck their finger up my butt. I was diagnosed with a blood test, by temperature and abdominal palpitation.

Believe it or not. Yes, it is still a procedure that can be done to rule out appendicitis. Improved imagery techniques may eliminate it but many docs still prefer to do one.

To support what @nurse_phillips said I think there is something important here. Medical procedures have varied along with time. Procedures that were once common have been phased out, for various reasons, including: a faster, cheaper, more precise, less harmful, less invasive, less painful, and/or less offensive to dignity method was found. Procedures that were once thought to be beneficial were found to have harmful side effects. Some procedures were found to be quite unnecessary.

This is especially true of child rearing. The exact same thing that was told to parents (with all the guilt implied: if you don't do this your child will suffer harmful effects) at one point was contradicted 1 or 2 decades later.

In addition, medical customs vary from country to country. Many things are not based in science, but in habits.

So in a nutshell, don't be surprised to hear of procedures you had never heard of.

@Pecan_nutjob and @Nurse_Phillips i agree. As the medical industry, in the US especially, has become more automated, a lot of people have forgotten or are unaware by their age that manual checks like rectal exams were practiced as a preemptive check. Even in the US, to @Pecan_nutjob ‘s point, where you are will likely differentiate how you are treated. For example, a suspected case of appendicitis in a small country town hospital emergency room or clinic would probably be more likely to be investigated with a rectal check compared to the same situation in a large city with a big hospital.

@turnheadandcough Right. Appendicitis is an emergency, and physicians don't have the time to send you somewhere else with more equipment (not every hospital or clinic has MRI or CT-scan, and they may be fully booked anyway). I had a digital rectal exam with our GP on a home call, and she basically had to decide whether or not to send me to the clinic.

@CassieST As far as I know, digital rectal exams are no longer commonly used for appendicitis diagnosis because there are more "modern" methods for them. What Nurse Philipps and I described happened in the 1970s.

Back in the 70's I had ongoing problems with my appendix and to my surprise my GP did a rectal examination. I certainly wasn't expecting it and it was the first one I'd ever had. To be honest, although it was unexpected the experience wasn't too bad at all, it was over fairly quickly and there was no discomfort involved.

@Dr_Philip It's unpleasant if you have acute appendicitis, because it's confirmed by pain when pressed at some location inside.

This is an interesting conversation. If you look at anatomy illustrations, the appendix is at the end of the cecum and there is quite a bit of space between the appendix and the walls of the rectum. Unless an appendix is really inflamed and enlarged, I don't think it would be possible to feel it while giving a rectal exam, but I'm not a doctor.

The DRE as a diagnostic tool has been evaluated and may be valuable is SOME limited situations:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557952/

“Overall, our analysis showed poor diagnostic performance of DRE for acute appendicitis….. The opinion that DRE is an indispensable, routine examination for evaluation of appendicitis should be reconsidered. “

“When the appendix hangs into the pelvis, abdominal findings may be entirely absent, and the diagnosis may be missed. Right-sided rectal tenderness is said to help in this situation.” Thus, the DRE could have an important role when the inflamed appendix cannot be evaluated through abdominal examination.

I attended medical school in the early 70s. According to the Chief of Surgery a patient merited exploration (surgical) if they had right lower quadrant pain and tenderness. You felt better if the white count was elevated. A rectal exam often confirmed tenderness in the RLQ. If felt a tender mass you might be dealing with an abscess. That was it. Nowadays it's a CT but they didn't exist in a practical sense till the 80s, even at larger hospitals.

When our son had his appendicitis there was no rectal exam given. The issue was confirmed by xray, I believe, then surgery was done.

Surprisingly in the 80's when I was 12 I had an appendix attack on New Years Eve. The 2 things I still remember clearly from the event was the DRE in the ER and the staff removing my gown in the OR for prep, was definitely not out yet. Not sure why those 2 things stuck.

@ggheat you never forget your first DRE. I guess that was your first one?

@fillthisguyup at 12 I would imagine so

I experienced the same when I was a young kiddo, halfway the seventies last century (hehe, that sounds old).

One day I had severe lower abdominen pain which prevented me to walk straight.

The male doc requested me to take down my pants and to lie down on the table sideways position, the same way as T.S. described.

Sideways on the exam table and knees to my chest.

Beside the doc, my dad was also in the room and was too shy to pull down my pants in front of them which the doc noticed.

So he told my dad to go outside together with him so I could strip down and go on the table.

Then his finger went in and the verdict was appendicitis.

I have unfortunately no remembrance anymore of how it felt or if he pushed painful spots.

It went away without operation, while these days it seems to be an operation is mandatory, so if that was appendicitis or something else I'll most likely never know.