Delayed bowel perforation in electrocution: An unpredictable foe

Abstract

Electrocution injuries, particularly high voltage, are uncommon, but can be devastating. Thermal burns, arrhythmias and myonecrosis are commonly known and monitored complications of electrical injuries. Direct thermal trauma to internal viscera is also known and almost all internal organs have been reported to be affected, bowel being the most common. However, bowel perforation occurring in a delayed fashion is one rare, dreaded and erratic complication of electrocution, making it a dangerous pitfall if missed. Alimentary tract perforations can present on a delayed basis in high voltage electrocution injuries; advise for clinical follow up must incorporate this possibility at the time of discharge. Presentation of delayed visceral injuries is subtle & atypical, and post burn immunosuppression may play a part for such presentation. We suggest that all victims of high voltage electrocution with abdominal wall burns receive diagnostic laparoscopy and/or CECT abdomen as part of workup of their injuries. Any non-enhancing segment of bowel on CECT, howsoever small, should be prudently evaluated with laparoscopy.

Keywords: Delayed diagnosis; Electric injuries; Intestinal perforation; Late presentation; Missed diagnosis.

Fig. 1

Circumferential & constricting eschar leading to compartment syndrome post electrocution.

Fig. 2

Perforation (3*2 inches) in mid-jejunum, presenting on day 6 of admission.

Fig. 3

Non-viable but intact segment of jejunum, secondary to thermal damage. Patient had large area abdominal wall burn from high-voltage electrocution. The suboptimal resolution is due to photograph being taken from a cell phone wrapped in plastic sheet, as a part of COVID OR protocol.