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LETTER TO EDITOR |
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| Year : 2006 | Volume
: 11
| Issue : 2 | Page : 110 |
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Adeniran's sign (in early generalized peritonitis in children)
JO Adeniran
Paediatric Surgical Unit, University of Ilorin Teaching Hospital, Ilorin, P. O. Box 5708, Ilorin, Nigeria
Correspondence Address:
J O Adeniran
Paediatric Surgical Unit, University of Ilorin Teaching Hospital, Ilorin, P. O. Box 5708, Ilorin
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-9261.25938
How to cite this article:
Adeniran J O. Adeniran's sign (in early generalized peritonitis in children). J Indian Assoc Pediatr Surg 2006;11:110 |
Sir,
Rebound tenderness elicited maximally at the umbilicus, in early peritonitis in children.
The anterior abdominal wall has 3 sheets of muscles which are muscular posterolaterally and aponeurotic anteromedially. These are the external oblique, the internal oblique and the transverses abdominis. The external oblique musle arises from the lower 8 ribs, radiates downwards and forwards, encloses the transverses and is inserted to the linea alba with the other side. The internal oblique arises from the lumbar fascia and the iliac crest, radiates upwards and forwards and is inserted to the linea alba. The fibres of the transversus are horizontally disposed, to attach to the linea alba. This arrangement gives maximum strength to the abdominal wall. The whole abdominal cavity with its lining peritoneum, is therefore separated from the abdominal skin by these strong sheets of muscles and re-enforced near the pubis with the pyramidalis.[1] The situation is, however, different at the umbilicus. Developmentally the umbilical cord connects the baby to the mother, in utero. The muscles are therefore deficient at the umbilicus. After birth, the umbilical area is left only as the umbilical cicatrix or umbilical ring, where only the skin separates the peritoneum from the abdominal skin, without an intervening muscle. Only a fibrous reminant separates the peritoneum from skin.[2] Irritation of the peritoneum is therefore easier to elicit at the umbilicus.
Irritation of the peritoneum in generalized peritonitis produces guarding, rigidity and rebound tenderness.[3],[4] But these signs are elicited through the thick muscles of the anterior abdominal wall. The peritonitis must therefore be grossly established, before these signs can be elicited. Umbilical hernias are common in infants and young children, especially of Afro-Carribean origin.[5] In children whose umbilical ring have previously closed, increased intra-abdominal pressure reopens the ring, causing eversion of the umbilicus.[2] In such children, only the thin skin separates the irritated peritoneum from the palpating finger. Rebound tenderness is thus most easily elicited at the umbilicus, in children with early peritonitis.
If peritonitis is suspected in a child, either the index or middle finger ONLY is used to sharply press and release the everted umbilicus. Rebound tenderness elicited at this umbilicus makes ADENIRAN'S sign positive and confirms peritonitis.
 References | |  |
| 1. | Romanes GJ. The abdomen. In : Cunningham's Manual of practical anatomy. Romanes GJ (editors) vol. 2. Oxford Med Publ: Oxford; 1986. p. 93-9.  |
| 2. | Moore KL, Dalley AF. Clinically oriented anatomy. 4th ed. Lippincott Williams and Wilkins: Canada; 1999. p. 186. |
| 3. | Darko R. Peritonitis and intraperitoneal abscesses. Principles and practice of surgery including pathology in the tropics, Badoe EA, Archampong EQ, da Rocha-Afodu JT (editors); 3rd ed. Ghana Publishing Corporation: 2000. p. 513. |
| 4. | Thompson J. The peritoneum, omentum, mesentery and retroperitoneal space. In : Bailey and Love's Short Practice of Surgery, Russell RC, Williams NS, Bulstrode CJK (editors); 23rd ed. Arnold: London; 2000. p. 1008-25. |
| 5. | Papagrigoriadis S, Browse DJ, Howard ER. Incarceration of umbilical hernias in children: A rare but important complication. Pediatr Surg Int 1998;14:231-2. [PUBMED] [FULLTEXT] |
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