Journal of the New Zealand Medical Association, 15-July-2005, Vol 118 No 1218
Vaginal water-jet injuries in premenarcheal girls
Tevita Aho, Vipul Upadhyay
Vaginal water-jet injuries may occur during activities such as waterskiing,1,2 jetskiing,3,4 and hydrosliding.5,6 Most reported cases involve adults, with only three previously described in premenarcheal girls.7–9 This paper describes two further paediatric cases, and discusses the management and prevention of such injuries.
An 8-year-old girl noticed lower abdominal discomfort, and heavy vaginal bleeding within minutes of playing on a high-pressure water fountain. She had been wearing a one-piece bathing suit. On examination in Accident and Emergency (A+E) at Starship Children’s Hospital (Auckland, New Zealand), she was haemodynamically stable with a soft, non-tender abdomen. There was a large volume of blood clot at the introitus, but no other external evidence of injury.
Emergency examination under anaesthetic (EUA) revealed a 4cm-long flap laceration in the middle-third of the vagina. An actively bleeding artery was diathermied and vaginal packing inserted. The packing was removed under anaesthetic the following day and the patient was discharged 2 days after admission with a serum haemoglobin (Hb) level of 8.8 g/dL (12.1 g/dLon admission).
A 10-year-old girl described immediate lower abdominal and pelvic pain after sliding feet-first with legs abducted down a hydroslide. Heavy vaginal bleeding followed soon after. She had been wearing a one-piece bathing suit. On examination in A+E continuing vaginal bleeding was noted but she was haemodynamically stable. There was no abdominal tenderness nor any obvious external injury. At EUA, a 4cm laceration of the proximal vagina was identified. There was generalised bleeding from the laceration but no specific bleeding vessel was identified.
Vaginal packing was inserted and removed uneventfully 30 hours later under anaesthetic. The patient was discharged after 3days. Serum Hb had fallen from 10.8 g/dL on admission, to 8.8 g/dL at discharge.
The cases described are uncommon but potentially serious, and resulted from watersport activities that are common in New Zealand. Vaginal injuries may result from the forceful entry of water into the vagina. Most water-jet injuries have been reported in adults who had a vaginal tampon in place at the time. Indeed, it has been hypothesised that water under pressure may induce a potentially injurious piston-like effect on tampons. However, as these two cases, and the three previously reported in
premenarcheal girls demonstrate, vaginal tampons are not a prerequisite for water-jet injury in this age group. In all cases, heavy vaginal bleeding resulted in early medical consultation. All patients were referred appropriately for specialist paediatric assessment and management, and significant vaginal lacerations were identified and treated.
Vaginal bleeding in premenarcheal girls soon after aquatic activities may be the only sign of significant vaginal injury. Diagnosis and treatment is usually straightforward but requires a general anaesthetic. When vaginal water jet injury is suspected, prompt referral to a paediatric centre for EUA is mandatory. It is important for medical personnel to be aware that major vaginal injury may result from seemingly innocent watersport activities.
Warning signs at aquatic centres and the use of wetsuits when participating in high-speed watersports could be considered as preventative measures.
Author information: Tevita Aho, Urology Registrar; Vipul Upadhyay, Consultant Paediatric Surgeon; Department of Paediatric Surgery, Starship Children’s Hospital, Auckland
Correspondence: Mr Tevita Aho, Consultant Urologist, Box 43, Addenbrooke’s Hospital, Hills Rd, Cambridge CB2 2QQ, UK. Fax: +44 1223 586982; email: firstname.lastname@example.org
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