What physical examination findings would suggest perforation of the bowel?

Rebound tenderness and rigidity are classic signs that suggest a perforation of the bowel. When there is perforation, the contents of the bowel can irritate the peritoneum, leading to peritonitis. As a result, you may observe abdominal rigidity, which is a protective response to inflammation. Rebound tenderness occurs when pressure is released from the abdomen, causing pain; this indicates irritation of the peritoneum. These findings can help point toward an acute abdominal condition requiring immediate medical attention, such as perforation.

Other findings, like decreased bowel sounds, localized tenderness, or a soft abdomen, may be present in different gastrointestinal conditions but are not specific indicators of bowel perforation. Decreased bowel sounds might suggest an ileus or obstruction rather than perforation, localized tenderness might indicate inflammation but does not imply generalized peritoneal irritation, and a soft abdomen often suggests the absence of significant intra-abdominal pathology. Thus, rebound tenderness and rigidity stand out as key indicators in this clinical scenario.