(132) Vaginal Laceration Requiring Operative Repair as a Result of a Jacuzzi Water Jet in a Prepubertal Girl

Background: Vaginal injury resulting from a high-pressure water jet has been documented in several case reports among adult women, especially in the context of water-skiing. There have been cases reported among prepubescent girls, but these cases appear to be rarer in the literature. We report an additional case to contribute to existing literature.

Case: An almost 10-year-old prepubertal patient presented to the emergency room with heavy vaginal bleeding after a fountain jet of a jacuzzi spa was turned on accidentally.
On external exam there was no evidence of pubertal development (Tanner 1). There was also no evidence of hymenal trauma on external exam, but there was evidence of significant recent vaginal bleeding. Due to the amount of vaginal bleeding, the decision was made to proceed with an exam under anesthesia and vaginoscopy. On vaginoscopy, a vaginal laceration was discovered in the posterior fornix from 3 o’clock to 9 o’clock. Fortunately, there was no evidence of peritoneal nor rectal injury. A repair of the laceration was undertaken using Vicryl 3-0 suture and hemostasis was obtained. This was a challenging repair due to its location high in the posterior vagina and the patient’s prepubertal status. After a brief period of observation, the patient was discharged home. The case was extensively discussed with colleagues, Medico-Legal Pediatrics, and the local youth protection service.

A followup with the family 6 weeks later revealed that the patient was doing well without any evidence of short-term complications.

Comments: This case adds to the literature documenting this rare but very striking clinical presentation of vaginal laceration from a high-pressure water jet. In this case, a complaint was filed with Health Canada in order to investigate the jacuzzi spa in question, so as to avoid future possible similar injuries.