Electrical burn injuries are often deceptive—external wounds may appear limited while devastating internal damage evolves silently. This rare case highlights a delayed ileal perforation with enterocutaneous fistula developing days after an electrical burn injury. The report underscores how electrical current can cause progressive transmural bowel necrosis, leading to late perforation and sepsis, even when initial abdominal findings are unremarkable.
Early suspicion, vigilant monitoring, and timely surgical intervention are critical to prevent catastrophic outcomes. This case serves as an important reminder for surgeons and emergency physicians: electrical burns demand long-term vigilance, not just initial stabilization.