Hydrostatic anorectal injury caused by fall from jet-ski

A 14-year-old girl, a rear seat passenger on a jet-ski not wearing suitable protective gear, was 'jumping' waves at a low velocity when she was ejected backwards off the vehicle, suffering a complex and unusual hydrostatic perineal injury as a result of the high-pressure water stream propelling the jet-ski. She presented to the emergency room with rectal bleeding and perineal and abdominal pain. Initial investigations revealed signs of anorectal injury and both intraperitoneal and extraperitoneal free air and fluid, suggesting a possible rectal perforation. Proctoscopy confirmed the primary diagnosis and exploratory laparotomy revealed an intraperitoneal tear in the rectal wall. The tear was repaired, and protective loop colostomy was performed. Initial results of anal manometry, transrectal ultrasound and anal electromyography were unfavourable. However, 17 months after pelvic floor physiotherapy and biofeedback, the colostomy was reversed, and her continence has returned to her normal (preinjury) state.