In what might sound like a medical anomaly confined to the annals of warfare medicine, cases of high-pressure transanal barotrauma causing serious colorectal injuries have been documented in a medical case series published in the Journal of Medical Case Reports [1]. These instances, although rare in general practice, highlight the dangers of compressed air tools when misused and the necessity for better awareness and education about their potential hazards.
This article will discuss the mechanism of these injuries, the case studies reported in the series, treatment and management approaches, and the implications for preventive measures and educational outreach.
Abstract
Traditionally associated with battlefield injuries, transanal high-pressure barotrauma leading to rectal blowout is less familiar in civilian medical cases. Such injuries happen when a high-pressure air jet overcomes the anal sphincter, injecting significant air volumes into the colon and causing ruptures when the burst pressure of the bowel wall is exceeded. We examine a case series presented in the Journal of Medical Case Reports, articulating the circumstances, treatment, and recovery of individuals who suffered colorectal injuries due to high-pressure barotrauma.
Introduction
Injuries to the rectum and colon due to foreign objects and intense pressure are not unknown to the medical field. However, the occurrence of high-pressure injuries leading to a rectal blowout outside of military warfare is exceedingly uncommon. In this news article, we report on a case series from the Journal of Medical Case Reports, which details three instances of high-pressure transanal barotrauma [1].
Case Series and Analysis
The article, authored by Lovenish Bains and colleagues, discusses three male adults who presented with injuries caused by accidental or deliberate exposure to a compressed air jet directed towards the anus [1]. The commonality among these cases is striking – each incident was either an unfortunate accident or a harmful prank, and all resulted in significant free gas in the peritoneal cavity, diagnosable via X-rays.
This type of injury typically occurs when high-pressure air is propelled into the rectum, rapidly inflating the colon and causing catastrophic tears, especially at the rectosigmoid junction – an area particularly vulnerable due to its natural anatomical configuration. The patients in the study required exploratory laparotomy, a surgical procedure to locate and repair the damage. Resection of the injured segments of the bowel was followed by the creation of a proximal ileostomy, effectively diverting the bowel’s contents to allow for the healing of the wounded area.
Compelling within these case studies is the sheer force the human colon can withstand before succumbing to pressure. The rectum’s configuration – fixed in place and with curves especially at the junction – creates a situation ripe for rupture under high-pressure conditions [2].
Mechanisms of Injury and Diagnosis
The mechanism of injury involves the overwhelming of the anal sphincter by a high-pressure air jet, resulting in insufflation of the colon with air [3]. The velocity and pressure of the air, coupled with the sigmoid colon’s susceptibility to high-pressure stress due to its angulations and fixed points, are key factors contributing to the injuries.
During the diagnosis, in addition to imaging showing pneumoperitoneum (free air in the abdominal cavity), patients typically present with abdominal pain, shock, and signs of peritoneal irritation indicating potential peritonitis due to contamination of the sterile peritoneal cavity with fecal matter.
Treatment and Recovery
Treatment protocols for high-pressure barotrauma to the colorectal regions require immediate surgical intervention. The management aims to stabilize the patient, repair the damage or perform a resection where necessary, and prevent septic complications [4]. In all cases from the case series, the patients underwent surgery to remove the affected segments and restore bowel continuity several months later. The recovery process is arduous but necessary to return to normal bowel function.
Preventive Measures and Education
There is a clear need for improved awareness about the safe operation of equipment that has the potential to cause such injuries. These cases exemplify the risk associated with ignorance and misuse of tools capable of delivering high-pressure air jets [5]. Education on the proper use and potential dangers associated with compressed air is essential to reduce the incidence of such life-threatening injuries.
Discussion and Implications for Practice
The rarity of high-pressure transanal barotrauma in civilians necessitates greater attention and knowledge dissemination. Medical professionals should be mindful of the symptoms associated with barotrauma and maintain a high index of suspicion when patients present with inexplicable abdominal pain and a history that suggests exposure to compressed air.
Research suggests the importance of appropriate training for individuals who work with or around machinery capable of delivering high-velocity air jets [6]. Moreover, there should be policies and regulations for the design and use of safety devices, such as pressure release valves that can prevent accidental over-insufflation, as well as rigorous enforcement of workplace safety standards [7].
Conclusion
Transanal high-pressure barotrauma causing colorectal injuries is a medical rarity outside combat zones but brings to light the devastating effects of the misuse of compressed air. As these case reports demonstrate, proper knowledge and cautious handling of such tools are imperative to prevent severe injury.
The cases reported by Bains et al. not only provided insights into the treatment and recovery journey of these individuals but served as a crucial reminder of the potential dangers of industrial equipment and the need for education on proper usage and safety practices.
References
1. Bains L, Gupta A, Kori R, Kumar V, Kaur D. Transanal high pressure barotrauma causing colorectal injuries: a case series. J Med Case Rep. 2019;13(1):133. doi:10.1186/s13256-019-2067-y.
2. Stone GW. Rupture of the bowel caused by compressed air. Lancet. 1904;2:216. doi:10.1016/S0140-6736(01)03460-2.
3. Jentschura D, Raute M, Winter J, et al. Complications in endoscopy of the lower gastrointestinal tract: therapy and prognosis. Surg Endosc. 1994;8(6):672–676. doi:10.1007/BF00678564.
4. Tulchinsky H, Madhala-Givon O, Wasserberg N, et al. Incidence and management of colonoscopic perforations: 8 years’ experience. World J Gastroenterol. 2006;12(26):4211–4213. doi:10.3748/wjg.v12.i26.4211.
5. Lüning TH, Keemers-Gels ME, Barendregt WB, et al. Colonoscopic perforations: a review of 30,366 patients. Surg Endosc. 2007;21(6):994–997. doi:10.1007/s00464-007-9251-7.
6. Thatte M, Taralekar SV, Raghuvanshi K. Colonic barotrauma with tension pneumoperitoneum – review of literature and report of a successfully treated case. Int J Sci Res (Ahmedabad). 2014;3(4):339–341.
7. Kozarek RA, Sanowski RA. Use of pressure release valve to prevent colonic injury during colonoscopy. Gastrointest Endosc. 1980;26(4):139–142. doi:10.1016/S0016-5107(80)73304-7.
Keywords
1. Compressed Air Injury
2. Rectosigmoid Junction Rupture
3. High-Pressure Barotrauma
4. Colorectal Trauma
5. Safe Work Practices
Digital Object Identifier (DOI): 10.1186/s13256-019-2067-y