A dangerous joke: Colon perforation by an air compressor

The most dangerous complication of air entry into rectum at a high volume and velocity in a short time are sigmoid colon rupture and pneumoperitoneum. We present a 28-year-old male was brought to emergency with abdominal nausea, vomiting, pain, and abdominal swelling for 4 hours. Based on physical examination and laboratory data the patient was taken to operating theatre for suspected acute appendicitis. On exploration an excessive amount of gas distention was observed in whole colon with caecum being more distended. There were serosal linear defects that were bleeding, with the largest being 3-4 cm, mainly in rectum. Larger defects were primarily closed. A more detailed patient history was taken and it was found out that he was pumped high-pressure air by an air compressor into his anus while joking with his friends. Air compressor abuse is one of the non-iatrogenic causes of barotrauma to colon. It usually occurs while working mates are joking with each other. In the rare cases where the cause of acute abdomen remains unclear it would be prudent to question the trauma history and use of an air compressor.