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Background: Probable typhoid fever is ≥ 38° Celcius fever at least 3 days that detects antigen but without isolation culture of Salmonella typhi. Tubex test have sensitivity 100% and specificity 90%. Complications occur including: 10-20% gastrointestinal bleeding, 1-3% intestinal perforation, 1-26% paralytic ileus. Confounding presentation and unsual features can pose a diagnostic dillema. Case: An 17-year-old man with abdominal pain complaint since 2 weeks with unclear location and severity by moving. Fluctuating fever since 3 weeks. Physical examination obtained distended abdomen, decreased intestinal sounds, diffuse tenderness, and impalpable hepatosplenomegaly. First day of admission obtained leukocytosis, tubex test score 8 and melena during treatment with ciprofloxacin for 10 days then improved with ceftriaxone. Patients provided good responds clinically and in laboratory. Discussion: Untreated typhoid fever can have surgical complications such as intestinal perforation and bleeding. The World Health Organization (WHO), the Indian Association of Pediatrics (IAP) established that fluoroquinolone, and cephalosporin are recommended as the first-line therapy. Conclusion: Reported a case with acute abdominal pain as presenting feature which were initially presumed to have a surgical emergency but were later on diagnosed to have typhoid fever.

Key words: typhoid fever, abdominal pain