A case of tetanus after surgery for strangulated bowel obstruction

A 69-year-old man developed generalized muscle spasms 9 days after undergoing surgery for a strangulated intestinal obstruction. He subsequently experienced respiratory failure and required mechanical ventilation in the intensive care unit. Tonic spasms were exacerbated by external stimuli, such as sound, and trismus emerged following tracheostomy. The patient was diagnosed as having tetanus, and targeted therapy was initiated, resulting in gradual clinical improvement. Tetanus is a neurotoxic syndrome caused by tetanospasmin, an exotoxin produced by Clostridium tetani, a bacterium commonly found in soil and present in human feces. Although rare, endogenous tetanus can occur following gastrointestinal surgery, likely due to translocation of the organism from the gut. This case highlights the need for clinicians to consider the gastrointestinal tract as a potential source of tetanus in postoperative patients presenting with muscle rigidity or spasms.