BEYOND THE TERMINAL ILIUM: TYPHOID PERFORATION WITH COLONIC EXTENSION IN RURAL CAMEROON - A CASE REPORT

Background: Typhoid intestinal perforation is a life-threatening complication of Salmonella typhi infection, most commonly affecting the terminal ileum at sites of Peyer's patch necrosis. Perforation involving the ascending colon is exceedingly rare and incompletely understood. We report a presumed case of typhoid perforation with colonic extension in a resource-limited rural African setting, and discuss the proposed pathophysiological mechanisms accounting for this atypical anatomical distribution.
Case Presentation: A 48-year-old female presented with a three-week history of high-grade fever, abdominal pain, and distension, with sudden clinical deterioration. Intraoperative findings revealed an extensive longitudinal intestinal perforation extending from the ileocecal junction to the ascending colon. In the absence of microbiological confirmation unavailable at our facility the diagnosis was based on clinical, epidemiological, and operative findings consistent with typhoid intestinal perforation. Surgical repair and broad-spectrum antibiotic therapy resulted in clinical recovery.
Conclusion: This case documents a rare pattern of intestinal perforation involving the ascending colon, presumed to be of typhoid aetiology, arising in a resource-limited setting. It contributes to a small but growing body of literature on colonic typhoid perforation and highlights the diagnostic and surgical challenges faced in rural sub-Saharan Africa. Potential pathophysiological mechanisms including contiguous ileocecal spread, mesenteric vasculitis, and bacteraemic seeding of colonic lymphoid follicles are discussed.