Kehr's sign

Referred pain at the tip of the shoulder (classically the left shoulder) caused by irritation of the diaphragm. It results from referred visceral pain being perceived in the shoulder due to shared cervical spinal nerve pathways (phrenic nerve, C3–C5).

Causes

• Intraperitoneal bleeding and splenic causes

  • Splenic rupture

  • Splenic abscess with diaphragmatic irritation

  • Splenic trauma

  • Ruptured splenic artery aneurysm

• Gynecological causes

  • Ruptured ectopic pregnancy with hemoperitoneum

  • Ovarian rupture or hemorrhage

  • Pelvic bleeding irritating the diaphragm

• Hepatobiliary causes

  • Cholecystitis

  • Hepatitis

  • Liver trauma or laceration

  • Subphrenic abscess

  • Biliary tract inflammation

• Other upper abdominal causes

  • Gastric perforation

  • Pancreatitis

  • Subdiaphragmatic infection or abscess

  • Intraperitoneal fluid or blood accumulation

• Other causes of diaphragmatic irritation

  • Pneumoperitoneum

  • Postoperative intra-abdominal irritation

  • Diaphragmatic inflammation