Is Abdominal Pain Common in Typhoid Fever?
Yes, abdominal pain is a common and characteristic presenting symptom of typhoid fever, occurring alongside fever in the typical clinical presentation, with perforation typically developing in the third week of illness. 1, 2, 3
Clinical Presentation and Frequency
Abdominal pain is one of the cardinal symptoms of typhoid fever. The disease characteristically presents with:
- Fever, relative bradycardia, and abdominal pain as the typical triad 4
- Abdominal pain and fever together represent the most common clinical presentation of enteric perforation, which typically occurs in the third week of disease (range 24 hours to 16 days) 1, 3
- Additional gastrointestinal symptoms including vomiting and diarrhea frequently accompany the abdominal pain 5, 6
Pathophysiology and Location
The abdominal pain in typhoid fever has specific anatomical correlates:
- The bacteria invade the submucous layer and proliferate in the Peyer's patches of the ileum, causing inflammation and pain 4
- Perforations most commonly occur in the ileum or jejunum, and less frequently in the colon and gallbladder 1, 3
- Hepatosplenomegaly develops at various stages and contributes to abdominal discomfort 5, 4
- Mesenteric lymphadenopathy and terminal ileum thickening are common findings on imaging 5, 6
Critical Warning Signs
When abdominal pain in typhoid fever is accompanied by peritonitis, this indicates life-threatening intestinal perforation requiring immediate surgical intervention:
- The presence of peritoneal signs (diffuse tenderness, guarding, rigidity) in a patient with prolonged febrile illness (2-6 weeks) is the typical presentation of typhoid perforation 2, 7, 3
- Free fluid in the pouch of Douglas indicates ileal perforation with peritoneal contamination, carrying mortality rates up to 60% 2, 7
- Signs of septic shock (systolic BP <90 mmHg, tissue hypoperfusion, skin mottling) require immediate aggressive resuscitation 2, 7
Geographic Context
Typhoid fever is the most common cause of gastrointestinal perforations in low-income countries, with high disease burden in areas with poor sanitation 1, 3. This contrasts sharply with high-income countries where typhoid is rare and primarily seen in returning travelers 6.
Common Pitfall
The major diagnostic challenge is that blood and bone marrow cultures are unavailable in most resource-limited settings where typhoid is endemic 1. Therefore, preoperative diagnosis relies on clinical findings of peritonitis in a patient with prolonged febrile illness 1, 3, making recognition of the abdominal pain pattern crucial for timely intervention.