Clinical and Medical Case Reports

Barotrauma was once very rare but recent reports of such incidents across the globe suggest that advances in the usage of high pressure compressed air for various purposes in the industrial environment has led to an increase in pneumatic injuries. Colorectal barotraumas are injuries that happen due to an elevated intraluminal pressure mainly by air and these injuries can vary from simple mucosal traumas to perforation of the bowel. We present a case of a 22-year-old boy, who presented to us with abdomen discomfort with subcutaneous emphysema in the abdomen and lower chest, following a prank played by his friend who had inserted a nozzle through his anal orifi ce and pumped high pressure condensed air through it. Computed tomography (CT) of the abdomen and pelvis showed evidence of air pockets in ischiorectal fossa and pelvis. Intraoperatively, we found rectal tears and large bowel serosal tears with distension of small bowel and large bowel. The tears were primarily sutured and a transverse loop colostomy was fashioned to facilitate healing of rectal wounds and to relieve the distension. Th ecolostomy was closed aft er eight weeks. Not many of such colorectal barotraumas have been reported and many of these injuries presented with bowel perforations and tension pneumoperitoneum. Most of these patients underwent surgery and very few patients were managed conservatively. Such variations in clinical presentations and the interventions which are done in these scenarios imply the need for further reporting of such injuries and its interventions for formulating better management protocols.