Emergency surgery was performed, revealing mid-transverse colon perforation and multiple serosal tears and contusions over the caecum and other parts of the colon (ascending, transverse, descending, and descending sigmoid colon). Primary closure of the perforation and diversion ileostomy were performed, followed by a 10-day stay in the intensive care unit. The patient was ultimately discharged with follow-up instructions. This case illustrates the potential dangers of air compressor injuries and emphasizes the need for prompt recognition and surgical intervention in cases of high-pressure intestinal barotrauma to prevent serious complications.

Intestinal barotrauma resulting from compressed air is a rare occurrence that typically arises due to accidental or sexual injury in industrial areas. The injury results when a high-pressure air jet column penetrates the anal sphincter barrier, leading to intestinal barotrauma upon burst pressure. The severity of the injury depends on various factors, such as air pressure, airflow velocity, anal resting pressure, and the distance between the source and the anus [1]. Tension pneumoperitoneum differs from simple pneumoperitoneum due to the presence of enormous tension in the peritoneal space, which can lead to fatal hemodynamics (inferior vena cava and splanchnic circulation) and respiratory compromise (elevation of the diaphragm) [2]. While injuries can range from mild to moderate (such as cat scratch colon) or severe (such as perforation or blowout) [3], injuries above and at the rectosigmoid junction are more common, while those distal to the rectosigmoid junction are seldom reported.

Expectant management is appropriate for individuals without clinical or radiological signs of peritonitis. In contrast, patients with peritonitis symptoms require surgical intervention, such as rectal tube decompression, intraoperative bowel decompression, resection of severe injuries, and perforation repair with proximal diverting colostomy or enterostomy if the bowel integrity is questionable [4]. In such cases, emergency physicians play a vital role in promptly diagnosing the condition, converting a tension pneumoperitoneum into an open pneumoperitoneum, and reducing the delay in surgical intervention. Death can occur due to complications such as air embolism, fat embolism, respiratory failure, acute heart failure, and hyperacute abdominal compartment syndrome, highlighting the importance of prompt diagnosis.