What is indicated by the obturator sign?

The obturator sign is a clinical indicator used in the assessment of acute appendicitis. It is elicited by having the patient flex the hip and knee and then internally rotate the hip, which stretches the obturator internus muscle. If pain is elicited in the right lower quadrant during this maneuver, it suggests irritation of the obturator nerve because of inflammation in the surrounding structures, most commonly associated with appendicitis.

This sign is particularly relevant in cases where the appendix is located in a higher position or when it is inflamed, potentially causing adjacent muscle irritation. While inflammation of the liver, ovarian cyst rupture, and fractured pelvis can present with abdominal pain, they do not specifically relate to the obturator sign in the same diagnostic capacity as acute appendicitis does. Thus, the correct answer reflects the relationship between the sign and its primary association with appendiceal inflammation.