Clinical features

Abdominal pain.

Features of hypovolemic shock. (cold extremities, hypotension, poor capillary refill, altered mental status)

Left hypochondriac tenderness. The patient may present with Kehr’s sign in which  pain is referred to the left shoulder on gentle palpation of the abdomen when the patient is lying down with legs elevated.

Features of Peritonism (Rebound tenderness and muscle guarding).