Cholelithiasis typically presents with right upper quadrant pain, as can pain from other right upper quadrant organs. Pain of cholelithiasis is often referred to tip of scapula. Professor Paddy Collins drew attention to fact that patients with gallstone pain would attempt to demonstrate this by placing their hand behind the back and thumb pointing upwards. This became known amongst his students as Collins’ sign.
AimTo evaluate accuracy of Collins’ sign as indicator of cholelithiasis.
Patients and methodsCase–control study performed on 202 patients with symptomatic cholelithiasis and 200 control patients (with oesophagitis, gastritis or duodenal ulcer). Questionnaire examined pain pattern in both groups. The results analysed using t test and χ2 test.
ResultsCollins’ sign was positive in 51.5% of gallstone patients and 7.5% of control group (P < 0.001).
ConclusionsCollins’ sign was positive in over half of all patients with cholelithiasis and was useful discriminator in diagnosis of gallstones.
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Bon Secours Hospital, Glasnevin, Dublin 9, Ireland
S. N. S. Gilani & T. N. Walsh
Academic Centre RCSI, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
S. N. S. Gilani, G. Bass, F. Leader & T. N. Walsh
Correspondence to S. N. S. Gilani.
Appendix 1 Appendix 1Questionnaire used in this study.
Age
Gender
Male
Female
Where do you get the pain (Draw a circle with one finger around where you get the pain)
Epigastrium
Retrosternal
Right upper quadrant
Left upper Quadrant
Central abdominal
Shoulder tip
Lower Abdominal
Other
Does the pain radiate to the back (Point: is the thumb pointing upward or downward)
Yes
No
Severity of pain (1–10)
Diagnosis (please encircle)
Oesophagitis
Gastritis
Duodenal ulcer
Cholelithiasis
About this article Cite this articleGilani, S.N.S., Bass, G., Leader, F. et al. Collins’ sign: validation of a clinical sign in cholelithiasis. Ir J Med Sci 178, 397–400 (2009). https://doi.org/10.1007/s11845-009-0404-7
Received: 21 June 2009
Accepted: 01 July 2009
Published: 14 August 2009
Issue Date: December 2009
DOI: https://doi.org/10.1007/s11845-009-0404-7
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