Pneumatic colon injury following high pressure blow gun dust cleaner spray to the perineum

A case of tension pneumoperitoneum with fecal peritonitis due to high-pressure air insufflation through the anus

Key Clinical Message

The reckless or ridiculous usage of high pressure compressed air could lead to disastrous consequences as demonstrated in this case. Injuries from a barotrauma can vary from a simple mucosal laceration to tension pneumoperitoneum causing abdominal compartment syndrome. Decompression by a wide-bore needle can be done as depicted in our patient to provide immediate relief.

Abstract

Rectal perforation most commonly occurs due to trauma, but rarely due to a high pressure compressed air passing through the anus as a part of playful joke. Owing to the belief of medico-legal issues and socio-psychological circumstances about the ano-rectal injury, initial approach to the medical facilities might be delayed, causing a delayed presentation and poor prognosis. We report an incident of a young male who presented with tension pneumoperitoneum causing abdominal compartment syndrome with fecal peritonitis due to forceful passing of high-pressure air through his anus. An initial decompression of the abdomen with a wide-bore needle was done at the emergency room. An emergency laparotomy with a primary repair of the rectal perforation by two layered sutures was done followed by a loop colostomy, 10 cm proximal to the injury. Colostomy closure was performed after 4 weeks. Post-operative recovery period was uneventful.

A case of transanal barotrauma by high-pressure compressed air leading to transverse colon perforation with extensive colon serosal tear

INTRODUCTION AND IMPORTANCE

Compressed air is used to apply paint, wash vehicles or machines, and remove water droplets after washing the precision instrument. Barotrauma due to high-pressure compressed air is extremely rare.

CASE PRESENTATION

We report a case of transverse colon perforation caused by a compressed air gun in a 20-year-old male. He used a compressed air machine to dust after work, and a coworker inserted compressed air transanally as a joke. Although he returned home once, he consulted a former hospital with worsening abdominal pain. Radiography and computed tomography (CT) revealed a massive amount of free air. The patient was admitted to our hospital. The patient underwent emergency surgery. Transverse colon perforation with extensive serosal tears and massive air bubbles inside the omental bursa were observed. Double-barrel colostomy using transverse colon perforation point for decompression and diverting the stoma at the ileum end was performed with serosal tear repair and abdominal cleaning drainage. Four months after the surgery, the patient underwent colostomy and diverting stoma closure.

CLINICAL DISCUSSION

The management of colon injury due to compressed air has two aspects: tension pneumoperitoneum and colon injury. The initial management of tension pneumoperitoneum is converted to open pneumoperitoneum and early emergency operation for colon injury is recommended as soon as full-thickness perforation is diagnosed.

CONCLUSION

Transanal high-pressure compressed air can cause lethal situations, and we encountered a similar case that required surgical intervention.

Colorectal barotrauma following compressed air spray to the perineum

Colorectal injuries caused by high-pressure air compressors are rare and reported especially among industrial workers. They may appear because of intended or accidental injury. In the present paper, we report a case of colorectal injuries due to air insufflation from a distance towards the anus with the clothes on, as a means of a practical joke. The patient presented one day after the trauma to the Emergency Department with complaints of severe abdominal pain and vomiting. On examination, he had signs of peritonitis. A computed tomography (CT) scan did not show any perforation. Emergency laparotomy was performed with the suspicion of pneumatic pressure-induced lesions. A total resection of the colon was made with enterostomy. The pathologic examination of the resected piece revealed multiple gangrenous areas without perforation associated to signs of peritonitis. Follow up was uneventful. A reversal of the enterostomy was scheduled.

Colorectal injury by compressed air: the rule of conservative therapy

We are reporting a case of colorectal injury caused by a jet of compressed air directed from a distance towards the anus. The patient mentioned that it happened accidentally while his colleague was cleaning his clothes using compressed air. The patient presented with acute abdominal pain and distension. A contrast CT study did not show any free air or leakage. The patient was treated conservatively, progressed well and was discharged from the hospital on the fourth day.

Emergency laparoscopic resection of the anterior rectum due to rectal trauma secondary to compressed air, case report

In the XIX century, the surgeon faces surgical challenges due to the creation of new technologies. Accidental or compressed air-induced injury to the colon and rectum is rare. We present the case of a 45-year-old patient who consults the emergency department, then a high-pressure rectal pneumatic trauma, with clinical findings of peritonism, managed with a Hartmann-type colostomy. and anterior resection of the rectum using laparoscopy, with findings of rectosigmoid perforation. With this, it can be demonstrated that minimally invasive surgery is a feasible approach in hemodynamically unstable patients without contraindication for pneumoperitoneum.

A Case of Pneumatic Rectal Perforation Caused by Compressed Air

Rectal perforation is a rare cause of acute abdomen. The most common cause of rectal perforation is trauma. Barotrauma due to the injection of compressed air in the rectum is an extremely rare cause of rectal perforation. We report a case of extensive pneumoperitoneum with abdominal compartment syndrome caused by rectal perforation secondary to the forceful injection of compressed air through the perineum. The patient was successfully managed by immediate relief of abdominal compartment syndrome by needle decompression followed by surgical repair of rectal perforation.

Pneumatic Colorectal Injury Caused by High Pressure Compressed Air

The pneumatic colorectal injury caused by high pressure compressed air are rare and can be fatal. Herein, we present a case of 45-year-old male who developed sudden onset of severe abdominal pain after cleaning the dust on his pants with high pressure compressed air gun dust cleaner. Emergent exploratory laparotomy was done which findings are a huge rectal perforation with multiple serosal and subserosal tear in sigmoid to splenic flexure of colon. Anterior resection with left hemicolectomy, and temporary transverse colostomy was performed. Postoperative course was uneventful. Recently, prognosis is generally favorable because of prompt diagnosis and emergent surgical management.

Cecum perforation secondary to plunger-induced barotrauma

Barotrauma to the colon and rectum is well documented, most commonly due to endoscopic complications. Here, we describe the unique case of a 56-year-old male presenting with peritonitis after self induced barotrauma to his colon following an attempt to alleviate 4-day obstipation with a toilet plunger. Exploratory laparotomy revealed a perforated and gangrenous right colon, which was promptly treated with an open right hemicolectomy and end-loop Prasad ileocolostomy. To our knowledge, this represents the first case of its kind and highlights the distinct pathology for colorectal barotrauma depending on the underlying mechanism of injury.

Rectal perforation by compressed air

As the use of compressed air in industrial work has increased, so has the risk of associated pneumatic injury from its improper use. However, damage of large intestine caused by compressed air is uncommon. Herein a case of pneumatic rupture of the rectum is described. The patient was admitted to the Emergency Room complaining of abdominal pain and distension. His colleague triggered a compressed air nozzle over his buttock. On arrival, vital signs were stable but physical examination revealed peritoneal irritation and marked distension of the abdomen. Computed tomography showed a large volume of air in the peritoneal cavity and subcutaneous emphysema at the perineum. A rectal perforation was found at laparotomy and the Hartmann procedure was performed.

Rupture of sigmoid colon caused by compressed air

Compressed air has been generally used since the beginning of the 20^th century for various applications. However, rupture of the colon caused by compressed air is uncommon. We report a case of pneumatic rupture of the sigmoid colon. The patient was admitted to the emergency room complaining of abdominal pain and distention. His colleague triggered a compressed air nozzle against his anus as a practical joke 2 h previously. On arrival, his pulse rate was 126 beats/min, respiratory rate was 42 breaths/min and blood pressure was 86/54 mmHg. Physical examination revealed peritoneal irritation and the abdomen was markedly distended. Computed tomography of the abdomen showed a large volume of air in the abdominal cavity. Peritoneocentesis was performed to relieve the tension pneumoperitoneum. Emergency laparotomy was done after controlling shock. Laparotomy revealed a 2-cm perforation in the sigmoid colon. The perforation was sutured and temporary ileostomy was performed as well as thorough drainage and irrigation of the abdominopelvic cavity. Reversal of ileostomy was performed successfully after 3 mo. Follow-up was uneventful. We also present a brief literature review.