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Typhoid: an unusual cause of gastro-intestinal bleeding.

Barium studies are rarely performed in patients with typhoid, though the radiological appearances have previously been described. A case is presented in which a barium enema and small bowel meal were carried out to elucidate the cause of an acute gastro-intestinai bleed in a febrile patient who had not been out of the United Kingdom for three years, nor in contact with recognised enteric infection. Non-diagnostic but characteristic changes were demonstrated, but only subsequently was the diagnosis of typhoid established by Salmonella typhi isolation in stool culture. Despite late institution of enteric precautions, the infection did not spread in the hospital. A 31-year-old black woman was originally seen as an out-patient with a 10-day history of fever, malaise, dry cough and anorexia; she had no headache, constipation or abdominal pain. She was born in Guyana but had lived in the United Kingdom for 28 years and had last been abroad (to Guyana) in 1980.