Complex perineal injuries from jet ski trauma: Case series highlighting surgical repair and reconstruction principles

Technological advancements have introduced new mechanisms of rectal injury, including hydrostatic pressure injuries from jet ski accidents. Approximately 20 cases have been reported, often involving extensive rectal, vaginal, and perineal disruption. Despite their severity, there are no established guidelines for managing these injuries or determining the optimal timing for reconstruction. This case series highlights the surgical management of four patients who sustained hydrostatic perineal injuries of varying severity. All patients were healthy young women who, while riding as rear passengers on high-speed jet skis, were ejected backward during acceleration, landing in a seated position onto the powerful propulsion stream. The resulting intense hydrostatic forces caused complex injuries, including complete disruption of the vaginal and rectal wall interface, leading to a traumatic cloaca. Each patient underwent fecal diversion and perineal reconstruction during their initial hospitalization, followed by successful colostomy reversal, with restoration of rectal tone and fecal continence. All four patients underwent CT imaging, rigid proctoscopy, distal rectal irrigation, colonic diversion, and anorectal repair with sphincter reconstruction during their index hospitalization. This approach led to satisfactory cosmetic outcomes, restoration of rectal tone, and maintenance of continence. The findings from this case series align with prior reports, further supporting fecal diversion and immediate perineal/sphincter reconstruction as an effective management strategy for hydrostatic perineal injuries.