This case report describes the acute care of a 19-year-old male who had several intestinal perforations caused by high-pressure air forced into the rectum—an uncommon and severe type of barotrauma. Initially, the patient showed significant tachycardia, a moderately compromised Glasgow Coma Scale score, and evidence of considerable internal injuries such as hemoperitoneum and bilateral pneumothorax, which were verified by diagnostic EFAST and CT scanning. The patient quickly progressed to hemodynamic instability, necessitating immediate resuscitation in the emergency room, including dual inotropic support and vigorous fluid resuscitation, followed by an emergency exploratory laparotomy. The anesthetic management was difficult, requiring cautious administration of Fentanyl and Hydrocortisone, as well as diligent monitoring during surgery. The multidisciplinary team approach, which included emergency physicians, surgeons, anesthesiologists, and critical care experts, was important to the patient's effective stabilization and subsequent management in the intensive care unit. This paper emphasizes the complexities of detecting and addressing atypical causes of abdominal injuries, as well as the significance of a well-coordinated, rapid-response healthcare team in effectively managing critical crises.