A 25 years old female presents with pyrexia for ten days, develops acute pain in periumblical region spreading all over the abdomen. What would be the most likely cause ?
.Paralytic ileus is the commonest complicationof typhoid. 2. Intestinal haemorrhage--as the Peyer's patches in terminal ileum are enlarged and ulcerated - 10%. 3. Perforation usually occurs in 3rd week of the infection. Ulcers are multiple, arranged in parallel and in antimesenteric border of the ileum. One or more ulcers might perforate and many ulcers may be on impending perforation. Patient is toxic, presents with-- * Severe diarrhoea * Relative bradycardia * Soft abdomen * Obliterated liver dullness * Abdomen without guarding and rigidity (because of Zenker's degeneration) * Initial history of fever for few days then pain abdomen and tenderness, which is progressive Associated Features-- 1. Splenomegaly 2. Fever, headache 3. Rose spots in the skin ref:SRB&;S manual of surgery,ed 3,pg no 803
Perforation peritonitis due to intestinal tuberculosis
Generalised peritonitis due to appendicular perforation
Typhoid enteric perforation and peritonitis
Acute salpingo-oophoritis with peritonitis
G.I.T