<prompt> 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 ?Perforation peritonitis due to intestinal tuberculosisGeneralised peritonitis due to appendicular perforationTyphoid enteric perforation and peritonitisAcute salpingo-oophoritis with peritonitis  <response>: .Paralytic ileus is the commonest complicationof typhoid. 2. Intestinal haemorrhage--as the Peyers 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 Zenkers 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 