Ileal perforation due to typhoid fevers

IIleal perforation due to Typhoid fever Clinical History
A 29-year-old male patient was admitted with complaints of fever for 2 weeks, abdominal pain and vomiting for 2 days, abdominal distension for 2 days, and not passing stools and flatus for 1 day.
He did not receive any treatment during 2 weeks. There was no history of long term abdominal pain and analgesic abuse, but patient was a chronic smoker and alcoholic.
There was no history of previous similar complaints
On examination, there was a mild distinction. Guarding and board like rigidity was present.
Bowel sounds were not heard. PR revealed empty rectum.
ESR was elevated, WBC count was 15200
Xray showed air under diaphragm
Hence a diagnosis of hollow viscous perforation was made.
Later, widal test was also found to be positive
Pathogenesis

Pathogenesis of typhoid intestinal perforations
Peyer patches become hyperplastic and subsequently ulcerate, with complications of hemorrhage or perforation
Differential Diagnosis
Includes appendicitis, appendicular perforation, perforated peptic ulcer, strangulated gut with volvulus, and necrotizing amoebic colitis
Management
Simple closure of the perforation is the treatment of choice and was done in this case.
With multiple perforations, which occur in about 25% of patients, resection with primary anastomosis or exteriorization of the intestinal loops may be required
References
Sabiston Text Book Of Surgery
http://www.meb.uni-bonn.de/dtc/primsurg/docbook/html/x11177.html