Barotrauma-induced Rectosigmoid Perforation Following Accidental High-pressure Compressed Air Insufflation: A Rare Case Report

ABSTRACT: Colorectal barotrauma due to accidental high-pressure compressed air insufflation is rare. Prompt recognition and intervention are critical. In this report, we present a case of accidental anorectal insufflation of compressed air leading to hollow viscus perforation. Radiographs and computed tomography imaging demonstrated massive pneumoperitoneum, pneumomediastinum, dilated small bowel loops, and diffuse sigmoid wall edema. Emergency laparotomy revealed a 3 cm × 4 cm perforation at the rectosigmoid junction. A Hartmann's procedure was performed with thorough peritoneal lavage and pelvic drainage. The patient recovered well postoperatively and was extubated on postoperative day 1 with full clinical stabilization achieved by day 4. In conclusion, high-pressure colorectal barotrauma can result in large perforations and massive extraperitoneal and intraperitoneal air leakage. Rapid imaging and emergent surgical intervention are essential to prevent morbidity and mortality. Hartmann's procedure remains an effective management strategy with improved prognosis in patients with significant contamination and large colorectal perforations.