Strypstein Sébastien, Claeys Simon, Smet Bart, Pattyn Paul
General and Abdominal Surgery, AZ Delta Campus Wilgenstraat, Roeselare, Belgium.
BMJ Case Rep. 2019 Aug 28;12(8):e229701. doi: 10.1136/bcr-2019-229701.
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?
一名既往健康的79岁女性接受了紧急剖腹手术，切除了一段绞窄性小肠袢。术后第二天，她出现了疑似术后破伤风的症状。为进行积极的支持治疗，有必要将她转至重症监护病房。患者需要接受5个月的强化物理治疗和康复治疗，最终成功出院回家。破伤风新发病例在发达国家已变得罕见。这种潜在致命疾病会影响未免疫和免疫不充分的患者。胃肠道手术后发生破伤风极为罕见。预防是关键，正确的免疫预防措施可以实现预防目的。老年患者往往免疫不充分。对于接受胃肠道手术的老年患者，是否应常规检查破伤风免疫预防情况？或者我们能否将免疫接种限制在患有坏死和/或腹腔污染的严重缺血性肠损伤病例？
