A Case of Intraperitoneal Bladder Rupture and Widespread Subcutaneous Emphysema Due to Self-Injurious Behavior in Paraphilia: Potential Roles of Hyperbaric Oxygen Therapy as an Adjunctive Treatment

A 42-year-old man presented with sudden abdominal pain during self-injurious sexual activity including the injection of high-pressure hot water into his urethra. He also self-injected carbon dioxide gas under the skin of the anterior chest. He was diagnosed with intraperitoneal bladder rupture and extensive subcutaneous emphysema. The bladder was surgically repaired, and then hyperbaric oxygen therapy was administered as an adjunctive treatment. The injury healed successfully, and the subcutaneous emphysema and pigmentation resolved promptly. This case suggests that hyperbaric oxygen therapy may be useful as an adjunct to surgical treatment and antibiotics for wound healing and as a treatment for subcutaneous emphysema.