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Traveled 300 kms by public transport, suffering from abdominal pain.
Soft tissue density material in paracolic gutters, medial to properitoneal fat planes, displacing bowel medially. Free gas is seen as 'football sign'.
Ultrasound demonstrates echogenic material in the peritoneal cavity, around the spleen and in the paracolic gutters.
Distal ileal perforations were found at laparotomy, typical of typhoid fever. There was gross fecal contamination of the peritoneal cavity.
The patient survived the operation but succumbed to overwhelming sepsis.