Atypical electrical injury leading to chest wall necrosis, multi-organ failure and terminal gastrointestinal bleed: A...

High-voltage electrical injuries (HVI) are usually life-threatening and are commonly caused by contact with high voltage power lines. They can lead to deep burns and multi-system trauma.

This report presents an atypical case of a 21-year-old male who had an accidental electrocution with high voltage power lines during a religious event, leading to a 4th-degree burn of the chest wall, right neck, pelvis, bilateral anterior thighs, perineum and both arms; the total body surface area (TBSA) was approximately 37 %. Deep chest wounds exposed the ribs, muscles and fascia. During his hospital stay, he developed several complications. The management of the wound included multiple debridements, reconstruction of the chest wall using a latissimus dorsi muscle flap, and split-thickness skin grafting from the left thigh. Initially the patient recovered but later developed lower gastrointestinal (GI) bleeding and expired due to hypovolemic shock.

This case highlights the complex management of HVIs involving extensive TBSA. Prompt surgical intervention is essential and includes coverage of deep wounds using a muscle flap, along with skin grafting for protection of the underlying structures. Due to the risk of systemic complications with such injuries, multidisciplinary care is required. In this case, the sudden onset of GI bleeding shows the unpredictable trajectory of such injuries.

HVIs involving extensive TBSA can result in rare but fatal complications. Prompt multidisciplinary management is crucial, and there is need for further research to improve outcomes and prevent complications in such complex cases.