EMERGENCY INTERVENTIONS
After you detect Kehr’s sign, quickly take the patient’s vital signs. If the patient shows signs of hypovolemia, elevate his feet 30 degrees. In addition, insert a large-bore I.V. line for fluid and blood replacement and an indwelling urinary catheter. Begin monitoring intake and output. Draw blood to determine hematocrit, and provide supplemental oxygen.
Inspect the patient’s abdomen for bruises and distention, and palpate for tenderness. Percuss for Ballance’s sign — an indicator of massive perisplenic clotting and free blood in the peritoneal cavity from a ruptured spleen.
Medical Causes
- Intra-abdominal hemorrhage. Kehr’s sign usually accompanies intense abdominal pain, abdominal rigidity, and muscle spasm. Other findings vary with the cause of bleeding. Many patients have a history of blunt or penetrating abdominal injuries.
Special Considerations
In anticipation of surgery, withhold oral intake, and prepare the patient for abdominal X-rays, a computed tomography scan, an ultrasound and, possibly, paracentesis, peritoneal lavage, and culdocentesis. Give an analgesic, if needed.
Patient Counseling
Explain all treatments to the patient and discuss any food or fluid restrictions.
Pediatric Pointers
Because a child may have difficulty describing pain, watch for nonverbal clues such as rubbing the shoulder.
REFERENCES
Khan, S., Muhammad, I., Laabei, F., & Rothwell, J. (2009). An unusual presentation of non-pathological delayed splenic rupture: A case report. Cases Journal, 2, 6450.
Kodikara, S. (2009). Death due to hemorrhagic shock after delayed rupture of spleen: A rare phenomenon. American Journal of Forensic Medical Pathology, 30, 382–383.
Kernig’s Sign
A reliable early indicator and tool used to diagnose meningeal irritation, Kernig’s sign elicits resistance and hamstring muscle pain when the examiner attempts to extend the knee while the hip and knee are flexed 90 degrees. However, when the patient’s thigh isn’t flexed on the abdomen, he’s usually able to completely extend his leg. (See Eliciting Kernig’s Sign.) This sign is usually elicited in meningitis or subarachnoid hemorrhage. With these potentially life-threatening disorders, hamstring muscle resistance results from stretching the blood- or exudate-irritated meninges surrounding spinal nerve roots.
Kernig’s sign can also indicate a herniated disk or spinal tumor. With these disorders, sciatic pain results from disk or tumor pressure on spinal nerve roots.
EXAMINATION TIP iciting Kernig’s Sign
To elicit Kernig’s sign, place the patient in a supine position. Flex her leg at the hip and knee, as shown here. Then try to extend the leg while you keep the hip flexed. If the patient experiences pain and, possibly, spasm in the hamstring muscle and resists further extension, you can assume that meningeal irritation has occurred.
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