A 56-year-old man was admitted with a 10 day history of persistent melena and a fever of two week's duration. On examination he was toxic; temperature 38°C, pulse rate 130/min, and BP 80/50 mmHg. Abdominal examination revealed tenderness in the right lower abdomen. Blood profile showed Hgb. 10.2 g/dl, total leucocyte count 3000/μl, GOT 120, and GPT 62 mU/ml. Blood and stool culture did not show any pathogenic bacteria. Fiberscopy and angiography did not detect any bleeding focus. He developed massive melena with peripheral circulatory failure resistant to blood transfusion. Emergency laparotomy was performed. Multiple ulcers in the terminal ileum with mesenteric lymphadenopathy were detected. Proximal 180 cm of ileum showed tell-tale sign on its serosal surface. Ileocecal resection was performed with the resection of the ulcer bearing area of the ileum. The culture from resected mesenteric lymph nodes was positive for Salmonella typhi organism. Histological examination of resected specimen showed massive intramural hemorrhage associated with infiltrated large lymphocytes and typhus cells. The patient made a rapid recovery with chloramphenicol therapy in the postoperative period.