A 26-year-old man with 10 days of continuous high-grade fever and relative bradycardia suddenly develops severe generalised abdominal pain. Examination shows guarding and rigidity; erect chest X-ray shows free air under the diaphragm. At laparotomy, a single perforation is found. Its most likely location is:
- A Antimesenteric border of the terminal ileum, within 60 cm of the ileocaecal valve ✓
- B Mesenteric border of the proximal jejunum
- C Caecum at the base of the appendix
- D Anti-mesenteric border of the sigmoid colon
Correct answer: A. Antimesenteric border of the terminal ileum, within 60 cm of the ileocaecal valve
Explanation
Typhoid (enteric fever) ulcers are longitudinal, run along the long axis of the ileum over hyperplastic Peyer's patches, and characteristically involve the antimesenteric border of the terminal ileum within about 60 cm of the ileocaecal valve, perforating classically in the third week of illness. Longitudinal orientation matters because it predisposes to stricture formation after healing. Jejunal, caecal, and sigmoid perforations suggest other pathologies such as tuberculosis, amoebiasis, or diverticular disease respectively.
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.