succussion splash

Q: How succussion splash (SS) can be demonstrated during the physical exam of a patient? 


Answer: Succussion splash can be elicited by placing the stethoscope over body area suspected of gas and fluid retention and rocking the patient back and forth vigorously. 

Demonstration of abdominal succussion splash is well known in Gastric Outlet Obstruction. It is due to the presence of gas and fluid in an obstructed stomach and indicates retained gastric contents for more than three hours after a meal. In abdominal SS, a patient is rocked by holding both hips. 

A less well-known and interesting demonstration of succession splash can be done in patients with achalasia or even hydropneumothorax. This is called thoracic succussion splash: a new symptom and sign of achalasia. A patient may himself described such sound with activities like jogging or bending. It can be heard both over the anterior and the posterior chest when the patient is rocked vigorously back and forth. 

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 References: 

1. Valle JD. Chapter 293. Peptic Ulcer Disease and Related Disorders. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012. 

2.  Sullivan SN. Thoracic succussion splash: a new symptom and sign of achalasia. . J Clin Gastroenterol. 1990 Dec;12(6):670-1.