GI EMERGENCIES · MEMBERSHIP SURGERY

Typhoid perforation — Korle Bu, Friday night

15 decision points ~28 min Difficulty 5/5 Membership

Setting

You are the on-call surgical registrar at Korle Bu Teaching Hospital, Accra. It is 21:00 on a Friday in mid-Harmattan. The elective list is finished. Two emergency theatres are notionally available but only one is currently staffed. You have a bedside ultrasound machine, a plain X-ray unit, and CT available on call within two hours.

Patient

Master B, a 22-year-old university student, was carried in by his roommate at 20:30. He has had eight days of high unremitting fever, headache, and profound anorexia. He was self-medicating with paracetamol and 'Malex' (a locally available antimalarial-antibiotic combination). At 14:00 today he developed sudden severe generalised abdominal pain which has worsened. He has vomited twice. His roommate says 'his belly went hard around 4pm.'

Reference stack

Bailey & Love 28e Ch 68 · Sabiston 21e Ch 46 · Hunter's Tropical Medicine 10e · WHO Typhoid Position Paper 2018 · Chatterjee World J Surg 2019

Start cascade →

You'll be asked to decide what happens next at each step. There's no timer — take your time. The correct answer + evidence-anchored rationale is revealed after each choice.