Literature review on hydrostatic vaginal and anorectal injuries caused by personal watercraft

Introduction The use of personal watercrafts (PWCs) has increased in popularity, size and engine power over time. Hydrostatic injuries when the passenger falls into water and the pelvic floor is directly hurt by the water jet remain rarely reported in literature but potentially lethal. Perineal, gynaecological and rectosigmoid regions present significant points of anatomical weakness to the force vector of the water. Biomechanical aspects on water-associated injuries on PWC may include disruption of the perineal soft tissues, inefficient anal sphincter and hydrodynamic insufflation. Methods This is a study involving a literature review from 1972 to 2020 using suitable search terms to identify all hydrostatic PWC injuries following PRISMA guidelines. Data were extracted from suitable articles on mechanism of injury, injuries sustained, treatment and outcomes. Results Thirty-two patients with major perineal, gynaecological and/or digestive injuries due to hydrostatic PWC traumas were identified. Major risk factors were female gender (84.4%), young age (25.5 years), being a rear passenger and wearing a standard swimsuit (100%). The injuries were digestive tract only (81.3%), gynaecological only (46.9%) or combined (28.1%). The interdisciplinary surgical management must include a vaginal and anal exploration under general anaesthesia and an exploratory surgery. Vaginal repair (41.9%) may be associated with a transanal anorectal suturing for lacerations of the intraperitoneal rectum (40.6%). A defunctioning stoma was performed in 62.5% and consisted of a loop sigmoidostomy (43.5%) or Hartmann’s procedure (34.8%) depending on laceration complexity. Conclusions PWC-related hydrostatic injuries are still rare but associated with a mortality rate of 6.3% which rises to 25% if initial haemodynamic instability was present. Expert guidelines such as adding an automated engine shut-off switch for the rear passenger and wearing a protective and safety clothing should be more widely respected.