Extensive Multicompartmental Air Dissection With Pneumoscrotum and Pneumorrhachis After Perineal Compressed-Air Injury Without Demonstrable Persistent Full-Thickness Rectal Perforation: A Case Report.

Anorectal barotrauma from compressed air is a rare but potentially life-threatening injury, and most published cases involve frank colorectal perforation, whereas extensive extraluminal air dissemination without a demonstrable full-thickness defect is poorly characterized. We report a previously healthy 21-year-old man who presented with acute anal pain after a coworker directed a high-pressure air jet toward his perineum through two layers of clothing. He was hemodynamically stable, with preserved anal sphincter tone and no rectal bleeding, but had widespread subcutaneous crepitus over the chest and abdominal wall and a tense, distended scrotum. Computed tomography (CT) revealed extensive air within the retroperitoneum, perirenal spaces, abdominopelvic fascial planes, and subcutaneous tissues of the chest, abdomen, perineum, and scrotum, together with intraspinal air consistent with pneumorrhachis; no discrete persistent rectal wall defect, large fluid collection, or fecal contamination was identified. No water-soluble rectal contrast leak study was performed; therefore, an occult sealed luminal communication could not be entirely excluded. Endoscopy at a tertiary referral center showed only superficial mucosal abrasion without a visible perforation, and the patient was managed conservatively with bowel rest, rectal lavage, and broad-spectrum antibiotics, recovering uneventfully. These findings suggest that extensive air dissection may occur through a sub-endoscopic mucosal breach or transiently sealed microperforation. CT was essential for mapping the air distribution and excluding high-risk features; in a stable patient without peritonitis, fecal contamination, or clinical deterioration, this supported cautious conservative management.