A case of burn evisceration with full-thickness injury to abdominal wall, bowel, bladder, and three extremities

Abstract Background Severe electrical burns are a rare cause of admission to major burn centers. Incidence of electrical injury causing full-thickness injury to viscera is an increasingly scarce, but severe presentation requiring rapid intervention. We report one of few cases of a patient with full-thickness electrical injury to the abdominal wall, bowel, and bladder. Case report The patient, a 22-year-old male, was transferred to our institution from his local hospital after sustaining a suspected electrical burn. On arrival the patient was noted to have severe burn injuries to the lower abdominal wall with evisceration of multiple loops of burned small bowel as well as burns to the groin, left upper, and bilateral lower extremities. In the trauma bay, primary and secondary surveys were completed, and the patient was taken for CT imaging and then emergently to the operating room. On exploration, the patient had massive full-thickness burns to the lower abdominal wall, five full-thickness burns to small bowel, and intraperitoneal bladder rupture secondary to full-thickness burn. The patient underwent damage-control laparotomy including enterectomies, debridement of bladder coagulative necrosis, and layered closure of bladder injury followed by temporary abdominal closure with vacuum dressing. The patient also underwent right leg escharotomy and partial right foot fasciotomies. The patient was subsequently transferred to the nearest burn center for continued resuscitation and comprehensive burn care. Conclusion Severe electrical burns can be associated with devastating visceral injuries in rare cases. Though uncommon, these injuries are associated with very high mortality rates. The authors assert that rapid evaluation and initial stabilization following ATLS guidelines, damage-control laparotomy, and goal-directed resuscitation in concert with transfer to a major burn center are essential in effecting a successful outcome in these challenging cases.

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Wound management and outcome of 595 electrical burns in a major burn center

Journal of Surgical Research ◽

10.1016/j.jss.2017.02.032 ◽

2017 ◽

Vol 214 ◽

pp. 182-189 ◽

Cited By ~ 9

Author(s):

Haisheng Li ◽

Jianglin Tan ◽

Junyi Zhou ◽

Zhiqiang Yuan ◽

Jiaping Zhang ◽

...

Keyword(s):

Wound Management ◽

Burn Center ◽

Major Burn ◽

Electrical Burns

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Radical tumor excision and immediate abdominal wall reconstruction in patients with aggressive neoplasm compromised full-thickness lower abdominal wall

The American Journal of Surgery ◽

10.1016/j.amjsurg.2012.04.007 ◽

2013 ◽

Vol 205 (1) ◽

pp. 15-21 ◽

Cited By ~ 13

Author(s):

Fei Yang

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Full Thickness ◽

Tumor Excision ◽

Lower Abdominal Wall

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Discussion on the Key Factors for the Treatment of Extremely High-risk Abdominal Trauma Patients With Partial Full-thickness Abdominal Wall Defects

10.21203/rs.3.rs-1078551/v1 ◽

2021 ◽

Author(s):

JiaQing Gong ◽

MingHui Pang ◽

Wei Li ◽

GuoDe Luo ◽

ZhiBing Yuan ◽

...

Keyword(s):

High Risk ◽

Abdominal Wall ◽

Abdominal Trauma ◽

Successful Treatment ◽

Damage Control ◽

Damage Control Surgery ◽

Abdominal Wall Defects ◽

Trauma Patients ◽

Full Thickness ◽

Key Factors

Abstract BackgroundPatients with extremely high-risk abdominal trauma and full-thickness necrosis and defects of the partial abdominal wall are clinically rare, and the treatments for these patients are very difficult and complex . In this study, we will explore the key factors for successful treatment of these patients . MethodsThree patients with extremely high-risk abdominal trauma and partial full-thickness abdominal wall defects were involved in this retrospective study, and one representative case was emphatically reviewed. According to the theory of damage control surgery,the consultation and coordinated treatment of multidisciplinary team(MDT) were involved firstly, then, stepped multiple operations,such as partial perforated small bowel resection, full-thickness abdominal wall defects repair, vacuum sealing drainage (VSD), and wounds skin grafts, were performed, meanwhile, systemic life resuscitation was strengthened. ResultsTwo patients were cured and discharged after 3 and 9 operations respectively. One patient suffered 2 operations and eventually died of lung infection and respiratory failure. ConclusionThe determination and responsibility of surgeons, rational use of damage control theory and multidisciplinary cooperation should be the keys for successful treatment.

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Management of traumatic small bowel injury by mechanical anastomosis “without resection” during damage control laparotomy

Journal of Visceral Surgery ◽

10.1016/j.jviscsurg.2016.03.003 ◽

2016 ◽

Vol 153 (3) ◽

pp. 209-212

Author(s):

H. Najah ◽

S. Noullet ◽

G. Godiris-Petit ◽

F. Menegaux ◽

C. Trésallet

Keyword(s):

Small Bowel ◽

Damage Control ◽

Bowel Injury ◽

Small Bowel Injury ◽

Damage Control Laparotomy ◽

Mechanical Anastomosis

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Abdominal wall heterotopic ossification following damage control laparotomy: an unusual bone to pick

ANZ Journal of Surgery ◽

10.1111/ans.16596 ◽

2021 ◽

Author(s):

Mathew O. Jacob ◽

Jonathan Reddipogu ◽

Jacob Jacob

Keyword(s):

Heterotopic Ossification ◽

Abdominal Wall ◽

Damage Control ◽

Damage Control Laparotomy

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Botulinum toxin A–induced paralysis of the lateral abdominal wall after damage-control laparotomy

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000000917 ◽

2016 ◽

Vol 80 (2) ◽

pp. 237-242 ◽

Cited By ~ 7

Author(s):

Martin D. Zielinski ◽

Melissa Kuntz ◽

Xiaoming Zhang ◽

Abigail E. Zagar ◽

Mohammad A. Khasawneh ◽

...

Keyword(s):

Botulinum Toxin ◽

Abdominal Wall ◽

Botulinum Toxin A ◽

Damage Control ◽

Toxin A ◽

Damage Control Laparotomy ◽

Lateral Abdominal Wall

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The Influence of a Pfannenstiel Scar on Venous Anatomy of the Lower Abdominal Wall and Implications for Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000003107 ◽

2017 ◽

Vol 139 (3) ◽

pp. 540-548 ◽

Cited By ~ 5

Author(s):

So Young Kim ◽

Kyeong-Tae Lee ◽

Goo-Hyun Mun

Keyword(s):

Breast Reconstruction ◽

Abdominal Wall ◽

Perforator Flap ◽

Inferior Epigastric Artery ◽

Venous Anatomy ◽

Epigastric Artery ◽

Deep Inferior Epigastric Artery ◽

Artery Perforator ◽

Lower Abdominal Wall

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A New Resuscitation Formula Based on Burn Index Provides More Reliable Prediction for Fluid Requirement in Adult Major Burn Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/irab013 ◽

2021 ◽

Author(s):

Jianglin Tan ◽

Junyi Zhou ◽

Ning Li ◽

Lili Yuan ◽

Gaoxing Luo

Keyword(s):

Fluid Resuscitation ◽

Linear Regression Analysis ◽

Fluid Volume ◽

Multivariate Linear Regression Analysis ◽

Burn Patients ◽

Full Thickness ◽

Burn Wound ◽

Major Burn ◽

Fluid Requirement ◽

Actual Volume

Abstract The Third Military Medical University (TMMU) formula is widely used in fluid resuscitation in China. However, the actual volume needs usually exceed the prediction provided by the TMMU formula in major burn patients with a high proportion of full-thickness burn wounds. This retrospective study included 149 adult major burn patients (≥40% TBSA) who were admitted to the Burn Department, Southwest Hospital from 2014 to 2020 and received appropriate fluid resuscitation by the TMMU protocol. The actual volume infused in the first 48 hours postburn was compared to the estimation by the TMMU formula. A new fluid volume prediction formula was developed by multivariate linear regression analysis. The mean fluid requirements were 2.35 ml/kg/% TBSA and 1.75 ml/kg/% TBSA in the first and second 24 hours postburn, respectively. The TMMU formula underestimated the fluid requirement, and its prediction accuracy was 54.1% and 25.8% for the first and second 24 hours, respectively. The proportion of full-thickness burn wound was found to be associated with the fluid requirements postburn. A revised multifactorial formula consisting of the burn index, body weight, and inhalation injury was developed. Using the revised formula, the prediction reliability of resuscitation fluid volume improved to 65.3% and 61.1% in the first and second 24 hours, respectively. The TMMU formula showed low accuracy in predicting fluid requirements among major burn patients. A revised formula based on burn index was developed to provide better guidance for initiative fluid resuscitation for major burns by the TMMU protocol.

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