Perineal Injury Secondary to High-Pressure Water Jet: Case Report

Abstract

Introduction: Anorectal trauma is an uncommon clinical entity that represents a diagnostic and therapeutic challenge due to the complex anatomy of the perineal region and the frequent involvement of adjacent pelvic structures. High-pressure water jet injuries, such as those associated with personal watercraft accidents, are a rare mechanism of trauma that can result in extensive disruption of the rectum, anal sphincter complex, and pelvic floor. The optimal management of these injuries remains controversial and should be individualized according to the extent of tissue damage and the patient´s clinical condition.

Case Presentation: We report the case of a 53-year-old female who sustained severe perineal trauma after falling from a jet ski and receiving a direct high-pressure water jet impact to the perineal region. Initial evaluation revealed extensive injuries involving the posterior rectal wall, anal sphincter complex, perineal body, and a vaginal laceration that had been primarily repaired at the site of the accident. Pelvic magnetic resonance imaging confirmed disruption of the elevator ani muscle and anal sphincters, as well as an approximately 10 cm rectosigmoid tear. The patient underwent surgical management consisting of extensive debridement and selective primary repair of the rectal wall and sphincter complex, followed by a laparoscopic diverting sigmoid colostomy. Postoperative recovery was favorable. Six months later, anorectal manometry demonstrated functional improvement after a structured pelvic floor rehabilitation program. Subsequently, laparoscopic colostomy closure with double stapled colorectal anastomosis was performed with an uneventful recovery. During follow-up, the patient achieved complete fecal continence with a Wexner score of 10.

Conclusion: Severe anorectal injuries caused by high pressure water jets are rare but potentially devastating. Early diagnosis, individualized surgical management, protective fecal diversion, and pelvic floor rehabilitation can lead to favorable functional outcomes, even in patients with extensive sphincter complex involvement.