Post-Traumatic Pneumoperitoneum Due to High Compression Trauma -A Case Report (original) (raw)
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International Journal of Surgery Case Reports, 2020
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.
SIGMOID COLON PERFORATION CAUSED BY COMPRESSED AIR: CASE REPORT
Indian Journal of Medical Research and Pharmaceutical Sciences , 2014
With the increasing of industrialization, usage area of high pressure air compressor became widespread. It has varied range of uses as a source of power for various tools and cleaning machines and fabrics. As a natural consequence of this, various organs and tissue injury including colorectal by using it except for the purpose has taken place in the literature. Colon injury as a result of bantering with high pressure air compressors especially among the workers around industrial fields is extremely rare but has serious morbidity and mortality rates. The case we described in this report is a case of sigmoid colon perforation in 37-year-old man who was harmed by compressed air that entered through the anus. In our opinion it is a unique cause of colonic perforation for about 150 cases of colon rupture by compressed air have been described so far. Sigmoid resection and colorectal anastamosis was performed and the patient discharged uneventfully.
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.
A Rare Case of Colorectal Injury with Compressed Air
2014
Colorectal injures from implement on solid objects are infrequent but not rare. In the same category are injuries caused by non solid objects. Barotrauma from compressed air and liquid is less frequently encountered. In our opinion it is a unique cause of colonic injury for about 150 cases of colon rupture by compressed air have been described so far. We report a case of 51 years old male presented with the history of insertion of compressed air tube into the anus by his friends for a practical joke. The patient had severe abdominal pain with the frequent desire to defecate since the incident. On examination there was a distension involving the lower abdomen with the diffuse tenderness. His vitals were unstable. Chest x ray and x ray abdomen erect revealed pneumoperitoneum. So we did laparotomy and repair of seromuscular tear at recto sigmoid part of colon. The postoperative period was uneventful and on regular follow up. It is being presented for its rarity.
Isolated Sigmoid Colon Perforation in the Setting of Blunt Abdominal Trauma: A Case Series
Cureus, 2022
Isolated colon injuries following blunt abdominal trauma have been reported with an incidence of 0.1-0.5 %, with sigmoid colon involvement being a rare entity. The sigmoid colon is reportedly involved only in 34.8% of isolated colonic injuries. The most common cause of colonic injuries is motor vehicle accidents. Contrastenhanced computed tomography has a role in blunt trauma-induced bowel injury evaluation, with 82% accuracy and 64% sensitivity, but its role in the diagnostic evaluation of colonic injuries is controversial. Surgical treatment comprises primary closure, resection with or without anastomosis, and/or colostomy formation. Primary anastomosis is often favored, while colostomy creation is generally required if devascularized bowel segments present or infrequently in hemodynamic instability scenarios. Subsequent gross presentation, treatment delays due to diagnostic difficulties, and scarcity of management guidelines contribute to high morbidity and mortality. Additional research is required to accurately define patient presentation and explore the benefits of different surgical treatment options. Hereby is a case series comprising three adult male patients who presented with delayed diffuse severe abdominal pain and distension following blunt abdominal trauma. Computed tomography evaluation in the latter two had findings suggestive of pneumoperitoneum. Post resuscitation, exploratory laparotomy done in each patient denoted isolated sigmoid colon perforation with and without associated mesenteric hematoma. The decision of primary closure, resection with rectosigmoid anastomosis, and resection with end colostomy creation was taken in respective cases based on intraoperative findings of contamination, vascularity, and hemodynamics. Previously documented reports have mentioned findings of associated intra-abdominal solid organ injuries, which were absent in the present case series.
Pneumatic colon injury following high pressure blow gun dust cleaner spray to the perineum
International Journal of Surgery Case Reports, 2015
INTRODUCTION: A pneumatic tool or air tool such as blow gun dust cleaner is a tool driven by compressed air and spraying of the perineum can insufflate the colon due to its high pressure and high flow rate. PRESENTATION OF CASE: We present a case of 4 year old boy who developed sudden onset of tense abdominal distention and developed peritonitis. Patient's family initially denied a history of trauma. Radiologic examination showed pneumoperitoneum and colon dilatation. Exploratory laparotomy revealed a tension pneumoperitoneum, bloody ascitic fluid, multiple site of ecchymosis and serosal tear of the colon and a minute perforation of transverse colon. Postoperative reinvestigation revealed that the patient's perineum was sprayed, using blow gun dust cleaner. DISCUSSION: Air from pneumatic tools produces column of air at pressure of 3.5-8.8 kg/cm 2 and pressure greater than the resting anal pressure of 0.109 kg/cm 2 force air to enter the colon when the perineum is sprayed. Different degree of colon injury results when airflow is greater than 1.46 L/m, and/or intraluminal pressure greater than 0.109 kg/cm 2. In most children, initial anxiety to tell the truth result in difficulty to obtain good history. CONCLUSION: Spraying of the perianal with excessive pneumatic force of greater than the resting anal pressure and high air flow rate causes multiple site colon injury and tension pneumoperitoneum due to colon perforation. Parent should be caution in children playing with high pressure pneumatic tool, and the importance of history is emphases for early correct diagnosis.
BMJ case reports, 2012
To present a case report of trans-anal barotrauma by high-pressure compressed air jet as a dangerous practical joke, that is, playful insufflation of high-pressure air jet through the anal orifice resulting in sigmoid perforation. The patient presented to emergency a day later with complaints of severe pain in the abdomen and abdominal distension following insufflation of high-pressure air jet through the anus. On examination, he had signs suggestive of perforation peritonitis and x-ray of the abdomen showed gas under the diaphragm. An emergency exploratory laparotomy was performed which revealed a 4-cm perforation in the sigmoid colon. Resection of the segment containing perforation along with the surrounding devitalised part was done with double-barrel colostomy. Reversal of colostomy was done after 8 weeks. Follow-up was uneventful.
Transanal high pressure barotrauma causing colorectal injuries: a case series
Journal of Medical Case Reports
Background: Rectal perforation by foreign bodies is known; however, high-pressure injury leading to rectal blowout has been confined to battlefields and is less often encountered in general medical practice. Apart from iatrogenic injuries during colonoscopy, barotrauma from compressed air is encountered very less frequently. Owing to the infrequent nature of these injuries, the mechanism is still not well understood. We present our experience with treating high-pressure transanal barotrauma to the rectum and colon in three similar cases. Case presentation: The mode of injury was accidental or a cruel, perverted joke played by acquaintances. The highpressure air jet column overcomes the anal sphincter barrier, pushing enormous amounts of air through the anus into the bowel, which ruptures when the burst pressure is reached. A huge amount of free gas was noted in the peritoneal cavity on x-rays, and a big gush was noted during surgery. All these cases had rectosigmoid junction blowout with multiple colonic injuries. The patients underwent exploratory laparotomy with resection of severely injured segments and proximal ileostomy. They underwent restoration of bowel continuity after 2-3 months and were doing well in follow-up. Conclusions: Colorectal injuries by pneumatic insufflation through the anus depends on the air pressure, air flow velocity, anal resting pressure, and the distance between the source and anus. The relative fixity of the rectum and the bends of the sigmoid make the rectosigmoid junction more prone to rupture by high-pressure air jet. Education regarding such machines and their safe use must be encouraged because most of these cases are accidental and due to ignorance.
Conservative management of traumatic pneumoperitoneum in a child
International Surgery Journal
Clinical practice guidelines for blunt trauma abdomen in children and adults advocate exploratory laparotomy when free air is detected on imaging. This conventional algorithmic approach of taking up for surgery when pneumoperitoneum is picked up, has its pitfalls as is illustrated in the case study where a child with polytrauma was managed conservatively despite free air on computed tomography (CT). The role of CT to detect bowel perforation, reasons for false positivity of free air in the abdomen and the key points in the successful non-operative treatment of the child have been discussed. Unlike, the only other report in a child with conservative management of pneumoperitoneum where the pneumoperitoneum can be explained secondary to blunt trauma chest, our report was unique in having other markers of bowel injury on CT and was in the absence of chest trauma. Response to injury in children is different compared to adults and allows for a higher success rate in conservative manageme...
Peritoneal Morphological Changes due to Pneumoperitoneum: The Effect of Intra-abdominal Pressure
European Journal of Pediatric Surgery, 2013
Introduction Carbon dioxide (CO 2 ) used in laparoscopy evokes local and systemic effects. This study was designed to evaluate the histopathologic morphologic changes due to CO 2 and air insufflation, at different pressure levels, on visceral and parietal peritoneum in rats. Materials and Methods A total of 56 rats were object of the study, randomly divided into five groups. Pneumoperitoneum (PN) was maintained for 30 minutes, at a flow rate of 0.5 L/min and at a pressure of 10 and 6 mm Hg with CO 2 (group S1-S2, n ΒΌ 32) and