Table 2 The treatment strategy for the douche injury related to a PWC

1. First, suspect perineal injuries due to mechanism of the douche injury

2. Stabilize vital signs (hemostasis, transcatheter arterial embolization, blood transfusion if necessary)

3. Perform necessary examinations (perineal visual examination/palpation, rectal examination, vaginal examination, contrast-enhanced torso CT, etc.)

4. Need to repair the anal sphincter and place a colostomy

5. Administer appropriate antibiotics estimated from the injured location (sea, lake, etc.)