Pneumatic colon injury following high pressure blow gun dust cleaner spray to the perineum

• Accident related pneumatic colon perforation is difficult to diagnose in children preoperatively as they are anxious to tell the history of trauma.
• The presence of pneumoperitoneum always leads to exploratory laparotomy.
• The sudden onset of tension pneumoperitoneum, intraoperative of multiple site colon injury with or without perforation in normal children should suspect the presence of trauma.
• Creation of ostomy at the site of normal looking colon preferable to colon resection.

IntroductionA pneumatic tool or air tool such as blow gun dust cleaner is a tool driven by compressed air and spraying of the perineum can insufflate the colon due to its high pressure and high flow rate.Presentation of caseWe present a case of 4 year old boy who developed sudden onset of tense abdominal distention and developed peritonitis. Patient’s family initially denied a history of trauma. Radiologic examination showed pneumoperitoneum and colon dilatation. Exploratory laparotomy revealed a tension pneumoperitoneum, bloody ascitic fluid, multiple site of ecchymosis and serosal tear of the colon and a minute perforation of transverse colon. Postoperative reinvestigation revealed that the patient’s perineum was sprayed, using blow gun dust cleaner.DiscussionAir from pneumatic tools produces column of air at pressure of 3.5–8.8 kg/cm2 and pressure greater than the resting anal pressure of 0.109 kg/cm2 force air to enter the colon when the perineum is sprayed. Different degree of colon injury results when airflow is greater than 1.46 L/m, and/or intraluminal pressure greater than 0.109 kg/cm2. In most children, initial anxiety to tell the truth result in difficulty to obtain good history.ConclusionSpraying of the perianal with excessive pneumatic force of greater than the resting anal pressure and high air flow rate causes multiple site colon injury and tension pneumoperitoneum due to colon perforation. Parent should be caution in children playing with high pressure pneumatic tool, and the importance of history is emphases for early correct diagnosis.