Pneumoscrotum is a rare condition with pelvic fractures. It is essential for the clinician to carefully trace the source of the air. We report a case of a 19-year-old patient with pneumoscrotum after a motorcycle accident; he presented at the emergency department with severe lower abdominal pain. During surgery, a rectal perforation was found to have caused the air leak. Possible mechanisms by which air becames localized in the scrotum are discussed.