Regarding clinical signs of abdominal disease, which of the following is associated with bowel perforation?

c. Rigler’s sign is a radiographic finding of bowel perforation. It manifests as a dual-enhanced image of the bowel due to the presence of air in the peritoneum and in the lumen of the bowel. Murphy’s sign is positive when pain is elicited over the right upper quadrant when two fingers are placed here and the patient asked to breathe in. An inflamed gallbladder will cause the patient to catch his or her breath. Rovsing’s sign relates to pain felt in the right iliac fossa when pressure is applied to the left iliac fossa and is associated with appendicitis. Kerr’s sign is pain felt in the shoulder tips associated most classically with ruptured ectopic pregnancy. This pain is referred pain from blood irritating the diaphragm and emphasises the common embryological relationship between the motor innervation of the diaphragm (C3, C4 and C5) and the sensory dermatome supplying the shoulder tips (C4). Trousseau’s sign in the context of abdominal disease relates to crops of tender nodules affecting blood vessels (thrombophlebitis migrans) often associated with pancreatic malignancy.