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| Journal of the New Zealand Medical Association,
15-July-2005, Vol 118 No 1218
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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.
Case reportsCase 1An
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).
Case 2A 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.
DiscussionThe 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: tevita.aho@addenbrookes.nhs.uk
References:
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