Turkish Journal of Surgery

Turkish Journal of Surgery

ISSN: 2564-6850
e-ISSN: 2564-7032


Ayşe Sena Çalış1, Esra Kaya1, Lijana Mehmetaj1, Büşra Yılmaz1, Elif Nurdan Demir1, Derya Öztuna2, Evren Üstüner3, Halil İbrahim Açar4, Serhat Tokgöz5, Muzaffer Akkoca5, Mehmet Ayhan Kuzu6

1Medical Student, Ankara University School of Medicine, Ankara, Turkey
2Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
3Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
4Department of Anatomy, Ankara University School of Medicine, Ankara, Turkey
5Department of General Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
6Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey


Objective: Medical textbooks suggest that the frequency of bowel sounds may be altered by performing auscultation after palpation or percussion. We hypothesize that the frequency of bowel sounds is not affected by the order of abdominal examination.

Material and Methods: Both healthy volunteers (n= 80) and patients (n= 100) were enrolled in this crossover randomized study. Two different examination orders, one as inspection, palpation, percussion, auscultation (IPPA) and the other order as inspection, auscultation, palpation, percussion (IAPP) were used by two observers, one of which was blinded to the order of the physical examination and only performed auscultation. Bowel motilities of 40 participants were analyzed with duplex Doppler USG by a radiologist. The effects of changing the order of abdominal examination and palpation-percussion maneuvers on the frequency of bowel sounds were evaluated.

Results: Gender distribution was similar between the healthy patients and controls, and mean age of the entire study population was 47 (18-60) years. Differences between the mean bowel sound frequencies for abdominal examinations in order IPPA-IAPP versus IAPP-IPPA were evaluated for both healthy subjects and the patients. There were no differences between the first and second listening, nor were there differences between examinations performed in either order. Duplex Doppler Ultrasonographic (USG) assessments were performed on 20 healthy subjects and 20 patients before and after palpation and percussion; there were no statistically significant differences between the two listenings (p= 0.694).

Conclusion: According to both abdominal examinations and Doppler USG, the order of auscultation, whether performed before or after palpation or percussion, did not change the frequency of bowel sounds in this subject population.

Keywords: Abdominal examination, bowel sounds, physical examination order

Cite this article as: Çalış AS, Kaya E, Mehmetaj L, Yılmaz B, Demir EN, Öztuna D, Üstüner E, Açar Hİ, Tokgöz S, Akkoca M, Kuzu MA. Abdominal palpation and percussion maneuvers do not affect bowel sounds. Turk J Surg 2019; 35 (4): 309-313.


Ethics Committee Approval

This study was approved by the Ankara University Faculty of Medicine “Clinical Research Ethics Committee” [Date: 27th January 2014, Number: 02-60-14]. All subjects provided informed consent prior to the start of the study.

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - A.S.Ç., M.A.K.; Design - A.S.Ç., E.K., L.M., M.A.K.; Supervision - A.S.Ç., B.Y., E.N.D., M.A.K.; Resource - A.S.Ç., H.İ.A., M.A.K.; Materials - A.S.Ç., E.K., L.M., B.Y., E.N.D., E.Ü., H.İ.A., M.A.K.; Data Collection and/or Processing - A.S.Ç., E.K., L.M., B.Y., E.N.D., D.Ö., E.Ü., H.İ.A.; Analysis and/or Interpretation - A.S.Ç., D.Ö., E.Ü., H.İ.A., S.T., M.A., M.A.K.; Literature Search - A.S.Ç., E.Ü., H.İ.A., M.A.K.; Writing Manuscript - All of authors; Critical Reviews - A.S.Ç., E.Ü., H.İ.A., S.T., M.A., M.A.K.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.