Small amounts of air swallowed when diving may expand during ascent (gastrointestinal barotrauma), usually causing self-limited symptoms.
(See also Overview of Diving Injuries.)
Breathing improperly from a regulator or using ear and sinus pressure-equalization techniques may cause divers to swallow small amounts of air during a dive. This air expands during ascent, causing abdominal fullness, cramps, pain, belching, and flatulence; these symptoms are self-limited. GI rupture rarely occurs, manifesting with severe abdominal pain and tenderness with rebound and guarding.
If signs of GI rupture are present, immediate upright chest x-ray or CT is done to detect free air. Milder symptoms require no testing.
Patients with GI rupture require aggressive fluid resuscitation, broad-spectrum antibiotic therapy, and immediate surgical consultation for possible exploratory laparotomy.