![]() 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. ConclusionsĬolorectal 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. They underwent restoration of bowel continuity after 2–3 months and were doing well in follow-up. The patients underwent exploratory laparotomy with resection of severely injured segments and proximal ileostomy. All these cases had rectosigmoid junction blowout with multiple colonic injuries. A huge amount of free gas was noted in the peritoneal cavity on x-rays, and a big gush was noted during surgery. The high-pressure 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. The mode of injury was accidental or a cruel, perverted joke played by acquaintances. We present our experience with treating high-pressure transanal barotrauma to the rectum and colon in three similar cases. Owing to the infrequent nature of these injuries, the mechanism is still not well understood. Apart from iatrogenic injuries during colonoscopy, barotrauma from compressed air is encountered very less frequently. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.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. The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). This is particularly important when the recommended agent is a new and/or infrequently employed drug. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. Usage and distribution for commercial purposes requires written permission. This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Doctors should be aware of the severe complications underlying barotrauma such as colon perforation if care is not taken until conclusion of the colonoscopy. It is relevant to identifying “cat scratch” colon as a benign condition. Cat scratch findings disappear naturally, so no other control colonoscopy is needed. We consider and believe that the retroflexion maneuver was not the cause of the findings. The images were taken before and after a retroflexion maneuver was performed in the cecum to get the best possible image and to show the relationship with the ileocecal valve. CRP or fecal calprotectin were not demanded. Once the patient was diagnosed with barotrauma, the colonoscopy was abbreviated to avoid more serious injuries. Biopsies were not taken, although microscopic colitis might be associated with this finding. It is reasonable to think that these marks are inherent to a less complacent colon or associated with situations that can favor bleeding, so we accept that they can be observed in any case where the colon suffers a barotrauma during the colonoscopy regardless of an underlying clinical disease. Although colonoscopy by using CO 2 could be less traumatic because of the easy absorption of the gas, there is not enough evidence to suggest that it will avoid the barotrauma. In the present case the colonoscopy was performed by the process of air insufflation. It is widely accepted by most authors that the marks are caused by intramural bleeding associated with intestinal distension that is caused by insufflated air during the colonoscopy.
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