Anorectal injury related to a personal watercraft: a case report and literature review

Abstract

Background Douche injury is a rare consequence of water recreation activities. Generally, this type of trauma occurs when people fall into the water in a sitting position during high-speed activities such as using a personal watercraft (PWC). Here, we report a rare case of anorectal injury caused by water jets from a PWC during sudden acceleration from rest. Case presentation A 21-year-old male passenger on a PWC fell off backward from the rear seat when the craft suddenly accelerated. He fell into the water in a supine position with his legs open, and the water jets of the PWC struck his perineum directly. Thereafter, bleeding from the anus was seen, and he was transferred to our hospital. On physical examination, there was a deep laceration interrupting the external anal sphincter in the posterior rectal wall. Abdominal computed tomography revealed a full-layer perforation of the posterior rectal wall and leakage of feces into the extraperitoneal space, but intraperitoneal free air was not seen. Laparoscopic sigmoid loop colostomy and primary suturing of the sphincter and mucosa were performed. He did not have any complications and was discharged from our hospital 16 days after the surgery. His anal function was almost perfectly preserved, and his diverting colostomy was closed 4 months later. Conclusion Anorectal injuries related to PWCs can occur not only while traveling at high speeds, but also when suddenly accelerating from rest. A diverting colostomy should be performed for this type of trauma. In these trauma cases, clinicians must suspect complex and life-threatening anorectal injuries early.

Management of a traumatic anorectal full-thickness laceration: a case report

“…Some authors observed, in appropriately selected patients, that secondary intention healing of extraperitoneal traumatic lesions of the rectum was possible. The conservative management of this type of full-thickness lesion has already been described in the literature after resection of rectal cancer and iatrogenic retroflexion rectal lesions during colonoscopy [12][13][14]. Associated urological injuries are common, with an incidence of approximately 25% in some studies, and although they are more frequent when the trauma is due to penetrating wounds, while approximately 40% of these injuries occurred following blunt trauma.…”

Perineal Injury via Personal Watercraft Hydrostatic Jet: A Case Report

“…Although not common, there are reports in the literature of serious and fatal intra-abdominal injuries secondary to perforation of the vagina, rectum, or bowel after penetration by a PWC hydrostatic jet (Atlas et al, 2015; Etienne et al, 2021; Gill et al, 2011; Katano et al, 2020; Litmanovich et al, 2021; Netz et al, 2015). Upon contact with the perineal area, as the PWC hydrostatic jet overcomes the resistance of the anal or vaginal sphincter, a column of liquid bursts into the body like a bullet and may perforate the vagina, rectum, or bowel (Gill et al, 2011).…”