Gynaecological complications of water-skiing

Recurrent Pol Ymicrobial Peritonitis from a Gynecologic Source as a Complication of CAPO

A 22-year-old woman on CAPD developed recurrent peritonitis with organisms suggestive of a gynecologic source. A concomitant vaginal leaking of dialysate confirmed an abnormal communication between peritoneum and vagina. The recurrent infection led to fungal overgrowth, abcess formation and catheter loss. The appearance of peritoneal infection with normal vaginal organisms should prompt a search for a gynecologic source of contamination such as that demonstrated in this case.

Water-Related Vaginal Injury: A Case Report and Review of the Literature

BACKGROUND

Vaginal injury can result from entry of water into the vagina under high pressure. Previously reported cases describe water-jet vaginal injuries in women participating in water-related activities, including: water skiing, personal watercraft use, waterslides, water hose and fountains, with and without foreign body in situ.

CASE

We describe the case of a severe vaginal laceration and hemorrhage in a 44-year-old female from a high-pressure water-jet generated during a water-ski fall requiring operative repair. Timely management resulted in excellent patient outcome.

CONCLUSION

A literature review demonstrated that, although uncommon, watersport-related gynaecologic injuries can be life-threatening, and women who regularly engage in watersports can be counselled regarding potential preventative measures. Physicians encountering patients with these injuries should rule out intraperitoneal injury and consider benefits of antibiotics.

Vaginal laceration from a high-pressure water jet in a prepubescent girl

OBJECTIVE

To document an unusual case of water douche injury in a prepubescent girl.

DESIGN

Case report.

RESULTS

After sitting atop a high-pressure water jet in a public fountain, a 9-year-old girl experienced pain and vaginal bleeding. She sustained a laceration high in her vaginal vault with an estimated total blood loss of 750 mL. Examination and vaginal packing were done under general anesthesia resulting in cessation of bleeding.

CONCLUSIONS

High-pressure water douche is recognized as producing serious vaginal injury in adult women but is not well reported as a cause of genital trauma in the pediatric population. Although not well documented, the prepubescent vagina is capable of receiving significant trauma due to highly pressurized water. Initial trauma management should be implemented with subsequent repair of the laceration, if possible. The prepubescent genital anatomy must be taken into account during examination and postoperative care.

Characteristics of water skiing-related and wakeboarding-related injuries treated in emergency departments in the United States, 2001-2003

BACKGROUND

Water skiing and wakeboarding are popular sports with high potential for injury due to rapid boat acceleration, lack of protective gear, and waterway obstacles. However, trends in water skiing- and wakeboarding-related injuries in the United States have not been described using national data.

HYPOTHESIS

The number of injuries, injury diagnoses, and body regions injured vary by sport.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Data regarding water skiing- and wakeboarding-related injuries presenting to 98 hospital emergency departments in the United States between January 1, 2001, and December 31, 2003, were extracted from the National Electronic Injury Surveillance System. Data included demographics, injury diagnosis, and body region injured.

RESULTS

Data were collected for 517 individuals with water skiing-related injuries and 95 individuals with wakeboarding-related injuries. These injuries represent an estimated 23 460 water skiing- and 4810 wakeboarding-related injuries treated in US emergency departments in 2001 to 2003. Head injuries represented the largest percentage of injuries for wakeboarders (28.8% of all injuries) and the smallest percentage for water skiers (4.3%) (P < .01; relative risk [95% confidence interval], 6.73 [3.89-11.66]). Analysis of injury diagnosis was consistent as wakeboarders had significantly more traumatic brain injuries (12.5% of all injuries) than did water skiers (2.4%) (P < .05; relative risk [95% confidence interval], 5.27 [2.21-12.60]). Strains or sprains were the leading injury diagnoses for water skiing (36.3% of all injuries), and the majority (55.7%) were to the lower extremity. Lacerations were the most common diagnoses for wakeboarders (31.1% of all injuries), and the majority (59.6%) were to the face.

CONCLUSION

The analyses of water skiing- and wakeboarding-related injuries treated in US emergency departments in 2001 to 2003 highlight the differences in injury patterns for these 2 sports. The substantial number of head and facial injuries among wakeboarders underscores the need for research on the potential role of helmets or other protective gear to reduce these common injuries.

The pregnant wilderness traveler

BACKGROUND

Travel during pregnancy, especially, when it involves potentially hazardous activities in remote areas, often raises serious concerns regarding the health and safety risks involved.

METHOD

The authors have researched the available medical literature to identify these risks and present the current recommendations for their prevention and treatment.

RESULTS

Topics addressed include some political and social issues, insurance, basic comfort measures, complications of pregnancy, infectious diseases, environmental exposures, and trauma. Preventive measures include pre-travel evaluation and teaching, possible modifications of the itinerary, vaccinations and medications. Also briefly discussed are the handling of obstetrical emergencies in the field and medical evacuation of the pregnant patient.

CONCLUSIONS

The authors conclude that many trips of this nature can be made relatively safe for the pregnant traveler, but she may need to accept some precautions and modifications of the itinerary that might not otherwise be necessary.

Rectal injury caused by a personal watercraft accident: report of a case

PURPOSE

An original case of rectal injury after a personal watercraft accident is reported. Principles of rectal trauma management are discussed.

METHODS

We present a case of a rectal injury after a fall from a personal watercraft. Rigid sigmoidoscopy and a water-soluble contrast enema documented a posterior rectal tear. The patient was managed by diversion, drainage, and administration of antibiotics.

RESULTS

The patient's rectal tear healed without complication.

CONCLUSION

To our knowledge, this is the first reported case of an injury to the rectum as a result of a personal watercraft accident. A high suspicion of rectal injury must be maintained in victims who have fallen from the back of a personal watercraft. Treatment of a rectal injury should follow the basic principles of drainage, diversion, and administration of antibiotics, but variations in traditional management may be appropriate. Finally, preventative methods including wearing protective clothing, and possible modification to the watercraft to reduce risk of injury should be considered.

Development of pelvic abscess following water-skiing injury

Several descriptions of hydrostatic injuries while water-skilng have been described, including lacerations of the perineum, vagina, and cervix. Salpingitis or pelvic abscess resulting from water-skiing injuries are rare but important complications. A case of a pelvic abscess following a fall while water-skiing is described. The abscess was drained laparoscopically, resulting in a good clinical outcome. The mechanism of injury and recommendations for prevention are also presented. Upper genital tract infection may result from water-skiing injuries due to hydrostatic pressure forcing bacteria and water through the vagina and cervix into the endometrium, fallopian tube, and peritoneal cavity. While an uncommon complication, physicians and other practitioners caring for women should be aware of this potential complication from water-skiing.

Nautical accidents. Unique injuries

Not much has been written about nautical injuries, although the increasingly popular recreational boating activities and other water sports are becoming a significant source of injury and death. The authors review common and not-so-common nautical injuries and possible preventive measures.

Can orthopaedic surgeons walk on water?

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Vaginal perforation due to jet ski accident

A case of full thickness vaginal perforation into the peritoneal cavity resulting from a jet-skiing accident is presented. Attention is drawn to the previously reported cases of similar injuries due to high speed water sports, and the need for adequate protective clothing in all people undertaking such sports.

Medical hazards of the water skiing douche

Many injuries can result from water skiing accidents, but the water skiing "douche" is unique to this sport. Although generally causing only discomfort, significant trauma can result from the forceful entry of water into the various body orifices. A case of otitis media attributed to this phenomenon is described. The hazards of vaginal and rectal laceration, salpingitis, tubo-ovarian abscess with resultant infertility, induced abortion, and associated complications are reviewed. In addition to sinusitis, otitis media and tympanic membrane rupture, other potential upper airway and auditory complications are enumerated.