Electrical Injury to the Anus is a Medical Emergency
Yes, electrical injury to the anus constitutes a medical emergency requiring immediate evaluation and transport to a medical facility, as electrical burns can cause severe visceral injuries with high morbidity and mortality that may not be immediately apparent. 1
Why This is an Emergency
Electrical injuries cause both visible and hidden damage. The current pathway through tissue creates thermal injury that extends beyond what is visible externally, and anorectal electrical injuries can cause:
- Third-degree burns to rectal mucosa and surrounding structures 2
- Perforation of the rectum and adjacent organs (vagina, small intestine, colon) 2, 1
- Delayed gastrointestinal complications including altered bowel function, increased stool frequency and urgency, and abnormal anal sphincter control that may not manifest for days to years 3
- Visceral organ damage to the colon, small intestine, heart, esophagus, stomach, pancreas, liver, gallbladder, lung, and kidney 1
Immediate Management Algorithm
At the scene:
- Do NOT touch the victim if still in contact with electrical source - shut off power first 4
- Call emergency services immediately 4
- Look for two external wounds (entry and exit points) and cover with dry dressing 4
- Monitor breathing and heart rate continuously 4
- Transport to medical facility as soon as possible 4
In the emergency department:
- Perform comprehensive abdominal and anorectal examination, including digital rectal examination and anoscopy 5
- Obtain CT scan of entire abdomen to evaluate for visceral injury, as this is the appropriate imaging modality for electrical trauma 5, 1
- Consider flexible sigmoidoscopy if anorectal injury suspected 3
- Monitor for cardiac arrhythmias as electrical current affects the heart 1
Critical Pitfalls to Avoid
The most dangerous assumption is that visible injury reflects the extent of damage. Electrical burns create a pathway of tissue destruction that extends far beyond surface wounds, and visceral injuries may not be immediately symptomatic 1.
Delayed complications are common and serious. Patients can develop gastrointestinal dysfunction, neurological symptoms (memory and concentration problems), and progressive anorectal dysfunction months to years after the initial injury 3. This means:
- All electrical injuries require hospital evaluation, even if the patient appears stable 1
- Patients need long-term follow-up for delayed complications 3
- Anorectal manometry and comprehensive neurophysiologic testing should be performed if symptoms develop 3
Why Anorectal Emergencies Require Prompt Recognition
The World Society of Emergency Surgery and American Association for the Surgery of Trauma emphasize that delayed diagnosis of anorectal emergencies is associated with adverse outcomes 6. While most anorectal conditions are not life-threatening, some can be life-threatening and require prompt recognition and treatment 6, 5.
Electrical injury to the anus falls into the life-threatening category because of the potential for perforation, sepsis, and multi-organ involvement 1.