He is alert, not toxic, resting comfortably. His hydration is good. Heart regular without murmurs. Abdomen is flat and generally soft. There is mild guarding and tenderness mostly over the periumbilical region.
Bowel sounds are absent.
No hernias are evident. Observing his gait, he ambulates slowly in a bent forward position. He refuses to jump. Asking him to cough results in moderately severe abdominal pain. A rectal exam does not yield any localizing signs.