Abdominal wall blow out causing bowel evisceration due to high voltage electrocution: A unique presentation

Abstract

A 32-year-old male presented to surgical casualty after 3 h of sustaining high voltage electrocution through palm of the right upper limb with prolapse of bowel from the anterior abdominal wall. Apparently, the current flow through the right upper limb exited from the right lower abdomen wall resulting in full-thickness abdominal wall defect causing small bowel to prolapse. He had clawing of right hand and semi-flexion at elbow with blackening and dry gangrene from mid-arm onward with distal two-third of the right upper limb being parched and black. There was 9 cm × 7 cm wound over right abdominal wall through which small bowel had eviscerated with multiple perforations discharging feculent content. Exploratory laparotomy with resections of perforated segments of small bowel with end-to-end anastomosis and right mid-arm guillotine amputation were done. The abdominal wound was debrided and temporarily covered with overlay plastic bag to prevent bowel herniation. A small enterocutaneous fistula arising from the small bowel was noted through the abdominal wound of blow out site, which was managed conservatively. The entry point of electricity is usually the skull or the upper extremity with resultant exit through the lower extremity. The exit point through the abdominal wall with resultant abdominal wall loss is rare and even remorsely seen is the abdominal wall blow out with the evisceration of bowel, a rare phenomenon.