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Collins’ sign: validation of a clinical sign in cholelithiasis



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.


To evaluate accuracy of Collins’ sign as indicator of cholelithiasis.

Patients and methods

Case–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.


Collins’ sign was positive in 51.5% of gallstone patients and 7.5% of control group (P < 0.001).


Collins’ sign was positive in over half of all patients with cholelithiasis and was useful discriminator in diagnosis of gallstones.

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Correspondence to S. N. S. Gilani.

Appendix 1

Appendix 1

Questionnaire used in this study.






Where do you get the pain (Draw a circle with one finger around where you get the pain)




Right upper quadrant

Left upper Quadrant

Central abdominal

Shoulder tip

Lower Abdominal


Does the pain radiate to the back (Point: is the thumb pointing upward or downward)



Severity of pain (1–10)


Diagnosis (please encircle)




Duodenal ulcer


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Gilani, 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).

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  • Collins’ sign
  • Cholelithiasis