Key Clinical MessageThe reckless or ridiculous usage of high pressure compressed air could lead to disastrous consequences as demonstrated in this case. Injuries from a barotrauma can vary from a simple mucosal laceration to tension pneumoperitoneum causing abdominal compartment syndrome. Decompression by a wide‐bore needle can be done as depicted in our patient to provide immediate relief.AbstractRectal perforation most commonly occurs due to trauma, but rarely due to a high pressure compressed air passing through the anus as a part of playful joke. Owing to the belief of medico‐legal issues and socio‐psychological circumstances about the ano‐rectal injury, initial approach to the medical facilities might be delayed, causing a delayed presentation and poor prognosis. We report an incident of a young male who presented with tension pneumoperitoneum causing abdominal compartment syndrome with fecal peritonitis due to forceful passing of high‐pressure air through his anus. An initial decompression of the abdomen with a wide‐bore needle was done at the emergency room. An emergency laparotomy with a primary repair of the rectal perforation by two layered sutures was done followed by a loop colostomy, 10 cm proximal to the injury. Colostomy closure was performed after 4 weeks. Post‐operative recovery period was uneventful.