Which sign indicates splenic rupture?

• A. Murphy's sign
• B. Rovsing sign
• C. Kehr sign
• D. Fitz-Hugh sign

Answer: (C)

Kehr sign is left shoulder pain produced by irritation of the diaphragmatic peritoneum from intraperitoneal blood, such as after splenic rupture. The blood stimulates the phrenic nerve (C3–C5) referred to the shoulder, so this left shoulder pain can be a key clue to splenic injury in a patient with left upper quadrant trauma or signs of hemorrhage.

In contrast, Murphy's sign is associated with gallbladder inflammation and causes inspiratory arrest with right upper quadrant palpation; Rovsing sign is pain in the right lower quadrant elicited by palpation of the left lower quadrant and points to appendicitis; Fitz-Hugh sign (in the context of Fitz-Hugh–Curtis syndrome) relates to perihepatitis and is not a marker of splenic rupture.