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Gall bladder perforation is an uncommon but dreaded complication. Spontaneous perforation in calculus cholecystitis is infrequent and even rarer in the absence of gallstones, but occasionally occurs following typhoid fever. 1 Surgical complications of typhoid fever more commonly involve the gut than the gall bladder and are commoner than those of paratyphoid fever. 2 When the two complications co-exist, the morbidity and mortality rates rise steeply, especially if they are not detected and treated in time. We report a rare complication: perforation of the gall bladder following ileal perforation in a patient with typhoid fever.