Bakka Havil Stephen Alexander, Babu Perumalla Karthik, Kutikuppala Lakshmi Venkata Simhachalam, Suvvari Tarun Kumar, Koirala Samrat Babu
Department of General Surgery Ramesh Sanghamitra Hospitals Ongole India.
Department of General Surgery Dr NTR University of Health Sciences Vijayawada India.
Clin Case Rep. 2023 May 15;11(5):e7344. doi: 10.1002/ccr3.7344. eCollection 2023 May.
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.
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.
如本病例所示，高压压缩空气的鲁莽或荒谬使用可能导致灾难性后果。气压伤造成的损伤范围从简单的黏膜撕裂到导致腹腔间隔室综合征的张力性气腹不等。如我们的患者所示，可通过粗针减压来立即缓解症状。
直肠穿孔最常见于外伤，但很少因高压压缩空气作为玩笑的一部分经肛门进入而导致。由于对肛肠损伤存在法律和社会心理方面的担忧，患者最初前往医疗机构就诊的时间可能会延迟，从而导致就诊延迟和预后不良。我们报告了一例年轻男性病例，该患者因高压空气经肛门强力进入导致张力性气腹，进而引发腹腔间隔室综合征伴粪性腹膜炎。在急诊室对腹部进行了粗针初始减压。随后进行了急诊剖腹手术，用两层缝合线对直肠穿孔进行了一期修复，然后在距损伤部位近端10厘米处进行了袢式结肠造口术。4周后进行了结肠造口关闭术。术后恢复期顺利。
