Douche injury related with personal watercraft fall: A case report

Case history,

Douche injuries are a rare consequence of high-speed water sports accidents, but can be life threatening and with high morbidity. This is a case of a 28 years old obese female, presented at the emergency department with vaginal bleeding after falling backwards as a passenger in a personal watercraft (PWC).

Clinical findings,

At admission, vital signs and neurologic status were stable. Gynecologic observation revealed a laceration on the anterior wall of the vagina. Hemorrhage was controlled with tamponade as patient becomes hypotensive with mental status deterioration.

Investigation/Results,

Blood tests showed 9,7 mg/dL hemoglobin, being otherwise normal. Stabilization was achieved with volemic resuscitation. Head CT showed no lesions. Thoraco-abdominal-pelvic CT revealed pneumoperitoneum with intraperitoneal effusion, air in the retroperitoneum, mesorectum and presacral space, without active hemorrhage or solid organ damage.

Diagnosis, Therapy and Progressions,

Patient was proposed for emergent laparotomy. At positioning extensive perianal lesions were observed with posterior anorectal laceration with total rupture of both sphincters. Laparotomy showed fecaloid peritonitis due to extensive longitudinal perforation of the middle/low rectum and full thickness laceration of the vaginal cupula. Anterior rectum resection with terminal colostomy, vaginal suture and sphincteroplasty with anorectal mucosal suture were performed. Patient was admitted in the ICU for post op and a 2º look at 24 hours was unremarkable being transferred to the ward on day 6. Post operative period was complicated with deep surgical site infection controlled with percutaneous drainage and antibiotics. Patient was discharged home on day 13.

Comments,

Injury mechanism in backward falls of PWC can cause extensive and important lesions in the perineal and pelvic organs. In this setting, clinicians must suspect complex and life-threatening anorectal injuries early.

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