The xiphoid process in clinical medicine

Abstract

Few references are to be found in medical literature to the association of the xiphoid process with disease. The case reports of two patients are here presented. The first patient is especially interesting as she throws light on a centuries old Maltese medical custom, which is dying out and is now practiced in the more isolated villages in the Maltese islands. These two patients illustrate first of all the ease with which the role of the xiphoid process in the production of symptoms may be completely overlooked. An erroneous diagnosis such as gastritis or even peptic ulcer can easily be made by a busy doctor if a patient indicates with one finger the localisation of pain in the upper epigastric region. A wrong diagnosis would be all the more possible if the patient is fully clothed when describing the symptoms at the beginning of the interview. In essence, this paper is intended to draw the attention of medical colleagues to the psychiatric, medical and even surgical aspects associated with the xiphoid process, whether because of the manipulative customs described above or through accidental self-manipulation or palpation.