High-voltage electrical injury resulting in visceral ischemia and loss of abdominal wall musculature: A case report

• Visceral ischemia is a rare complication of electrical injury. • Clinical severity may initially be underestimated in electrical injury. • Multispecialty management is required in patients in large burn injury. • Mesh reconstruction approximates abdominal wall closure. High-voltage electrical injuries are uncommon but can cause severe multisystem damage that may not be apparent on initial evaluation. We report the case of a 24-year-old male who sustained a high-voltage electrical injury after contacting a power line, presenting with 42% total body surface area full-thickness burns, hemodynamic instability, rhabdomyolysis, and intra-abdominal injury. Emergent exploratory laparotomy revealed ischemic bowel requiring resection, and examination of the extremities prompted urgent escharotomies and fasciotomies. His hospital course was complicated by progressive abdominal wall necrosis, ischemic enteritis requiring additional bowel resection, and irreversible ischemia of the left upper extremity necessitating amputation. This case highlights the evolving and often delayed manifestations of electrical injury, emphasizing the need for early burn center management, serial reassessment, and aggressive multidisciplinary care.