A 34-year-old man admitted on day 17 of undulant fever develops sudden severe abdominal pain with guarding. Abdominal radiograph shows free air under the right hemidiaphragm. Laparotomy reveals a single perforation. The most likely site of perforation is:

• A Terminal ileum over Peyer patches ✓
• B Cecum at the base of the appendix
• C Transverse colon at the mesenteric border
• D Duodenum at the first part

Explanation

Typhoid intestinal perforation is the most lethal complication of enteric fever, classically occurring in the third week of illness. It results from necrosis of hyperplastic lymphoid follicles (Peyer patches) in the terminal ileum, usually producing a single perforation on the antimesenteric border within about 30 cm of the ileocecal valve. Colonic and duodenal sites are rare. Presentation as acute abdomen with pneumoperitoneum in a febrile patient from an endemic area strongly suggests this diagnosis.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.