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Forgotten pathogen: tetanus after gastrointestinal surgery
  1. Sébastien Strypstein,
  2. Simon Claeys,
  3. Bart Smet and
  4. Paul Pattyn
  1. General and Abdominal Surgery, AZ Delta Campus Wilgenstraat, Roeselare, Belgium
  1. Correspondence to Dr Sébastien Strypstein, sebastien.strypstein{at}


A previously healthy 79-year-old woman underwent an urgent laparotomy and resection of a strangulated loop of small bowel. On the second postoperative day, she developed symptoms suspicious for postoperative tetanus. A transfer to the intensive care unit was necessary for aggressive supportive therapy. The patient required 5 months of intensive physiotherapy and rehabilitation and was successfully discharged home. New cases of tetanus have become rare in developed countries. This potentially lethal disease affects both non-immunised and inadequately immunised patients. The occurrence of tetanus after gastrointestinal surgery is extremely rare. Prevention is key and can be achieved with correct immunoprophylaxis. Older patients are often inadequately immunised. Should tetanus immunoprophylaxis routinely be checked for elderly patients undergoing gastrointestinal surgery? Or can we limit the immunisation to severe cases of ischaemic bowel injury with necrosis and/or soiling of the abdominal cavity?

  • gastrointestinal surgery
  • vaccination/immunisation
  • healthcare improvement and patient safety
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  • Contributors SS and SC designed the paper, reviewed the literature, contributed important ideas and wrote the paper. PP and BS designed the paper, contributed important ideas and revised the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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