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What is the diagnosis?
Pneumoperitoneum presumably from a ruptured viscus. Dilated loops of bowel imply either an ileus (secondary to peritonitis) or an obstruction.
What sign is elegantly demonstrated in the right upper quadrant?
Rigler sign (also known as the double-wall sign), referring to gas outlining both surfaces of the bowel wall - luminal and serosal.
Numerous small bowel loops outlined by gas both within the lumen and free within the peritoneal cavity. There is also ascites, with mottled gas densities over bilateral paracolic gutters.