Background: Tetanus is a life-threatening clostridial neurotoxin mediated infection which is not a rare disease in the developing countries. In the recent century, although a major development had achieved for the protection of this fatal infection in the pediatric populations; but same success have not been met for the adults and geriatric age groups. Most common presenting
symptoms of tetanus are trismus (risus sardonicus), dysphagia and abdominal rigidity, and thus general surgeons or maxillofacial surgeons may be involved in the early stages of the disease for urgent evaluations. Immediate and accurate diagnosis is essential to initiate prompt anti-toxic management and intensive therapy for a covetable outcome.
Case Report: This article is a report of fatal generalized tetanus in an elderly man with an unfortunate misdiagnosis of acute abdomen which had resulted by hazardous superfluous laparotomy with misleading signs of abdominal rigidity and pulmonary embolism.
Conclusions: Traditionally, the medical literature describes a certain population as at risk for tetanus infection and the disease still remains as an important threat in elderly people because of insufficient immune-protection. Mass vaccination campaigns are needed to improve tetanus immunization in these individuals, in developing countries. Tetanus should be considered in
the differential diagnosis of abdominal rigidity and pulmonary embolism in these countries, especially in the geriatric age groups. Delay in diagnosis and/or immunotherapy is the main reason of the fatality.

Keywords: Tetanus -- surgery, Abdomen, Acute