Vaginal and Rectosigmoid Hydrostatic Trauma Caused by Personal Watercraft

A 19-year-old woman wearing a standard 2-piece swimsuit was sitting on the back of a personal watercraft (PWC) passenger and fell off backwards. She remained haemodynamically stable. An abdominal computed tomography (CT) scan confirmed significant intraperitoneal fluid, faeces and free air (Figure 1). The rectoscopy revealed lacerations of the anal sphincter, superficial rectal lacerations and complex perforation of the rectosigmoid junction. The patient underwent Hartmann’s procedure, peritoneal lavage for faecal peritonitis, drainage and transanal sphincter repair under amoxicillin and clavulanic acid antibiotic coverage. The patient was discharged on postoperative day 12. Five months later, colostomy takedown and reanastomosis was performed without any continence issue so far. Another 20-year-old female patient wearing a 2-piece swimsuit was thrown off as a rear passenger during PWC riding. She was transferred to our hospital in a stable condition with perineal bleeding and vaginal pain. The abdominal CT scan revealed emphysema in the left periadnexal and perirectal space indicating disruption of the vagina and intraperitoneal perihepatic free air and fluid. Perineal examination under general anaesthesia confirmed vaginal disruption with externalization of small bowel. Exploratory laparoscopy highlighted an intraperitoneal disruption of the posterior vaginal fornix (Figure 2) without bowel injury and was treated by transvaginal suturing. The patient was discharged on postoperative day 2. Hydrostatic PWC accidents are rarely reported in the literature. Lesions of the perineum, posterior vaginal fornix and rectosigmoid junction occur when the pelvic floor is directly injured by the water jet stream. The main risk factors remain young age, female gender, rear passenger and non-protective standard swimsuit. The interdisciplinary management consists of proper resuscitation, if possible augmented by CTscan. Anal and vaginal examination under anaesthetic should accompany abdominal exploration. Depending on the complexity of the intestinal injuries, the exploratory surgery may necessitate a defunctioning loop sigmoidostomy or Hartmann’s procedure.