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• We reviewed 91 cases of intestinal perforation complicating typhoid fever treated at a rural hospital in Haiti over a ten-year period. Surgical management involved simple primary closure of the perforation (80 patients), small-bowel resection with anastomosis (two patients), simple drainage of the peritoneal cavity (two patients), and serosal patching of the perforation (one patient). Six patients died before surgery. The mortality was 30.8% for all 91 cases but 21.2% for those treated with primary closure of the perforation. We also reviewed the literature pertaining to the management of intestinal perforation complicating typhoid fever. (Arch Surg1983;118:1269-1271)

MALIGNANT tumors of the small intestine account for about 2% of all gastrointestinal malignancies.1The majority of these lesions are adenocarcinomas, followed by carcinoid tumors, lymphomas, and sarcomas. The most common site for carcinoid tumors is the appendix, followed by the jejunoileum. The most common clinical manifestation of jejunoileal carcinoids is small-bowel obstruction.1,2Gastrointestinal bleeding from jejunoileal carcinoids is rare but is surgically correctable. It is often difficult to locate the source of small intestinal hemorrhage prior to exploratory laparotomy. We recently treated a patient with multiple jejunoileal carcinoids associated with massive gastrointestinal hemorrhage. This case is presented along with a complete review of the pertinent literature to update the workup and treatment of bleeding small-bowel tumors. Report of a Case A 53-year-old man was admitted to the University of Miami/Jackson Memorial Medical Center on June 12, 1984, with near syncope. His medical history included chronic iron deficiency anemia