Which of the following indicates a possible perforation or rupture of the appendix?

Rovsing's sign is an important clinical indicator that can suggest possible perforation or rupture of the appendix. This sign is elicited by palpating the left lower quadrant of the abdomen, which causes pain in the right lower quadrant if appendicitis is present. When the appendix becomes inflamed, increased pressure can lead to complications such as perforation. Therefore, a positive Rovsing's sign, indicating this referred pain, may suggest a worsening condition, including the potential rupture of the appendix.

Cullen's sign, while significant, typically indicates internal bleeding rather than specifically a perforated appendix. It presents as a bluish discoloration around the umbilicus due to hemorrhage in the peritoneal cavity. Murphy's sign is used to assess gallbladder inflammation and isn't specifically related to appendicitis or its complications. Brudzinski's sign is associated with meningitis and involves involuntary flexion of the legs when the neck is flexed, making it unrelated to appendiceal issues. Each of these signs points to different clinical scenarios that do not directly indicate a perforated appendix as effectively as Rovsing's sign does.