![]() ![]() Conflict of InterestĪuthors declare no conflict of interest. Data AvailabilityĪll relevant data are within the paper and its Supporting Information files. Written informed consent was obtained from the patient for publication of this article. The corresponding author is the guarantor of submission. Kaushik Bhattacharya - Conception of the work, Design of the work, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. TR Gopalan - Conception of the work, Design of the work, Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The overall mortality of pneumatic rupture of the bowel was 65% and if the patient survives the initial shock, surgical intervention reduced mortality to 42%. The decision for urgent exploratory laparotomy is a must to decrease the mortality after pneumatic colon injury. Management lies in converting a tension pneumoperitoneum into an open pneumoperitoneum akin to tension pneumothorax. Timely intervention is required in such cases to save the life of the victim. It is particularly important for the surgeon to immediately prepare himself and his team for urgent laparotomy. Elevation of the diaphragm due to pressure from below decreases the lung volume affecting ventilation. The surgeon should prepare himself to relieve the tension pneumoperitoneum percutaneously with a Veress needle or a cannula. ![]() The patient may develop respiratory distress and hemodynamic instability due to tension pneumoperitoneum. According to the various colonoscopy studies the intraluminal pressure required to perforate the colon was greater than 0.109 kg/cm 2 (1.547 psi/80 mmHg). The human colon bursts with only about 120–200 mmHg of pressure and that seromuscular rupture occurs at lower levels. It has been seen that the normal colon can withstand a considerable high intraluminal pressure before getting ruptured and the sequence is, when pressure progressively increases, serosal tear occurs first, followed by the muscle and the mucosa in the end. Injuries may vary from “cat scratch” colon in mild types of iatrogenic barotrauma to colorectal perforation or blowout in the severe variety. According to the law of Laplace where the tension in the wall is proportional to the radius of the lumen, the risk of iatrogenic barotrauma occurs mostly in caecum due its largest diameter in the entire colon. Dozens of pneumatic colon injury cases have been reported since the first report by Stone in 1904. The histopathology report came as caecum showing congestion and areas of hemorrhage consistent with traumatic caecal perforation.Ĭolonic barotrauma due to compressed air may happen because of perversion or accidental injury in industrial zones. Postoperative course was uneventful, and the patient was started on oral diet on the 4th postoperative day and discharged on the 10th postoperative day in a stable condition. Resected specimen was sent for histopathology examination. There was no surgical emphysema or pneumo-mesentery. The difference in caliber during the anastomosis between ileum and transverse colon was adjusted with a bit of cheating. End to end two layer anastomosis was done with polyglactin 910 and mersilk ( Figure 2). After a thorough peritoneal toileting, a limited right hemicolectomy with Ileoascending anastomosis was done. In view of limited localized contamination, decision was taken to avoid any diversion and go for limited resected and anastomosis of the perforated colon. On table, a lacerated caecum and contused proximal ascending colon with minimal soiling in the right paracolic gutter was found. There was no anal or perineal injury externally. The patient was immediately shifted for exploratory laparotomy ( Figure 1). An emergent bed side X-ray chest revealed pneumoperitoneum. Immediate resuscitative measures were initiated with intravenous fluids and Foley’s catheterization. History from an attender revealed a prank of inserting a pneumatic cuff of an automobile tire into his anus and inflating it. He had thready feeble pulse of 130/min, gasping for breath and cyanotic, blood pressure (BP) was 70/50 mmHg and respiratory rate was 40/min. He was barely able to speak or give any type of intelligible history. A 20-year-old male patient was brought to the Emergency Department in a collapsed condition. ![]()
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