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[Postoperative tetanus after gangrenous ileus]
C Beisland1, S Kolltveit, B H Nilsen
1Kirurgisk avdeling, Lillehammer fylkessykehus.
Abstract:
Tetanus has become an uncommon disease in developed countries. Tetanus is caused by exotoxins from the bacteria Clostridium tetani. This microbe, which is obligate anaerobe, is present in soil, and animal and human faeces. The condition usually appears after contamination of wounds. However, reports have been published of tetanus occurring after both acute and selective gastrointestinal surgery. We present a case of severe postoperative tetanus in a 57 year-old woman who underwent bowel resection after strangulation of the ileum. The patient was treated on an intensive care unit and was artificially ventilated for 64 days. Seven months later she had fully recovered. Clinical presentation, diagnosis, treatment, and complications are discussed in the report. The diagnosis of tetanus is made by clinical observation. Nowadays, lack of suspicion of this condition may cause delay in administering proper treatment. Women and older men are often inadequately immunized. Doctors should therefore examine the immunization status of these groups of patients regularly.
Insights
Tetanus, caused by Clostridium tetani bacteria, is rare but can occur post-surgery. Early diagnosis and prompt treatment are crucial for patient recovery, especially in inadequately immunized individuals.
Area of Science:
- Infectious Diseases
- Microbiology
- Surgical Complications
Background:
- Tetanus is an uncommon but serious disease caused by Clostridium tetani exotoxins.
- Clostridium tetani is an obligate anaerobe found in soil and feces, typically causing infection via wound contamination.
- While rare, tetanus has been reported following gastrointestinal surgery.
Observation:
- A case of severe postoperative tetanus in a 57-year-old woman following bowel resection for ileum strangulation is presented.
- The patient required intensive care and mechanical ventilation for 64 days.
- Full recovery was achieved seven months post-treatment.
Findings:
- Diagnosis of tetanus relies on clinical observation; delayed diagnosis can impede timely treatment.
- The patient's severe presentation highlights potential complications of Clostridium tetani infection.
- Successful management involved intensive care and prolonged artificial ventilation.
Implications:
- Healthcare providers should maintain a high index of suspicion for tetanus, even after surgery.
- Regularly assessing and addressing the immunization status of women and older men is critical.
- Improved awareness and prompt intervention can lead to favorable outcomes in severe tetanus cases.