Noniatrogenic Colorectal Barotrauma with Extraperitoneal Rectal Injury

We present the case of a 22-year-old male 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 orifice and pumped high-pressure condensed air through it. Computed tomography showed evidence of air pockets in the ischiorectal fossa and pelvis. Intraoperatively, we found large-bowel and small-bowel distension with large-bowel serosal tears and rectal tears. The tears were primarily sutured and a transverse loop colostomy was fashioned to facilitate healing of rectal wounds and to relieve the distension. The colostomy was closed after 8 weeks. The postoperative period turned out to be uneventful. We intend to present this case to sensitize the readers about the unusual mode of presentation and our management which we hope would help the medical fraternity who might encounter similar scenarios.