What does rebound tenderness mean in acute appendicitis?
Oct 30, 2025
Source: Cainiu Health
Dr. Wang Lei
Introduction
Rebound tenderness in acute appendicitis may result from inflammation of the appendix stimulating the peritoneum, visceral nerve reflexes, localized peritonitis, peri-appendiceal abscess, or appendiceal perforation. This can be managed through rest and immobilization, anti-inflammatory medications, or surgical treatment. If rebound tenderness worsens or is accompanied by high fever, chills, or other severe symptoms, immediate medical attention is required. During acute appendicitis, the appendix becomes congested and swollen.
Rebound tenderness in acute appendicitis may result from peritoneal irritation due to appendiceal inflammation, visceral nerve reflexes, localized peritonitis, periappendiceal abscess, or appendiceal perforation. This can be improved through rest and immobilization, anti-inflammatory medications, or surgical treatment. If rebound tenderness worsens or is accompanied by high fever, chills, etc., immediate medical attention is required.
1. Peritoneal irritation caused by appendiceal inflammation: In acute appendicitis, the appendix becomes congested and swollen, and inflammatory exudates directly irritate the parietal peritoneum. When pressure is applied and then suddenly released, the peritoneum is stretched, causing rebound tenderness, often accompanied by fixed tenderness in the right lower quadrant. Bed rest is recommended, along with avoidance of strenuous activity to reduce peritoneal irritation. Prompt diagnostic evaluation should be performed to determine the severity of inflammation.
2. Visceral nerve reflex: Inflammation of the appendix stimulates visceral nerves, leading to abdominal muscle tension. During abdominal palpation, protective muscle contraction occurs; upon release of pressure, sudden muscle relaxation intensifies peritoneal irritation, resulting in rebound tenderness, which may be accompanied by nausea and vomiting. Fasting and fluid restriction are advised temporarily to reduce gastrointestinal burden and prevent symptom exacerbation, while awaiting further diagnosis and treatment.
3. Localized peritonitis: Inflammation from acute appendicitis spreads to the surrounding peritoneum, causing congestion and edema of the peritoneum, leading to localized peritonitis. Upon release of palpation pressure, peritoneal irritation symptoms become evident, causing rebound tenderness, along with abdominal muscle rigidity and fever. Patients may be prescribed intravenous medications such as ceftriaxone sodium injection, metronidazole injection, or levofloxacin injection under medical supervision to alleviate symptoms.
4. Periappendiceal abscess: If acute appendicitis is not treated promptly, inflammatory encapsulation may form an abscess. The abscess compresses and irritates the peritoneum, causing rebound tenderness upon release of pressure, accompanied by a palpable mass in the right lower abdomen, low-grade fever, and fatigue. Under medical guidance, antibiotics such as amoxicillin-clavulanate potassium tablets, cefuroxime axetil tablets, or ornidazole capsules may be used to manage symptoms. In some cases, percutaneous abscess drainage may be necessary.
5. Appendiceal perforation: Progression of acute appendicitis can lead to appendiceal perforation, allowing intestinal contents to leak into the abdominal cavity and strongly irritate the peritoneum. Rebound tenderness upon release of pressure is severe and is accompanied by generalized abdominal tenderness, high fever, and chills. Treatment includes administration of antibiotics such as piperacillin sodium-tazobactam sodium injection, cefoperazone-sulbactam sodium injection, or tinidazole injection as prescribed, along with prompt surgical intervention.
In daily care, closely monitor changes in abdominal pain and body temperature. After surgery, gradually resume diet as directed by your doctor, progressing from liquid to regular food. Keep the surgical wound clean and dry to prevent infection and promote healing.
