Aim: This study was designed to identify the incidence, injury patterns, and financial burden of ditch-related injuries to provide a reference for establishing guidelines on the prevention of such injuries. Methods: A retrospective chart review in a tertiary care hospital in Okayama city, Japan, focused on patients injured following a ditch-related fall and requiring intensive care between April 2012 and August 2013. Analysis was carried out to describe the epidemiology of ditch-related injuries. Results: Thirteen patients (median age, 60 years) met the inclusion criteria. The median time lag between the fall and rescue was approximately 1.5 h. Ten patients were injured in residential areas, and three were injured in rural areas. Eight patients were riding a bicycle at the time of the accident. Head and spine injuries predominated, although there were two cases of drowning, of which one died. The injury severity score ranged from 1 to 50 (mean, 17.8 ± 13). At the time of discharge from the intensive care unit, 6, 4, and 1 patients were classified into cerebral performance categories 1, 3, and 4, respectively. There were two in-hospital deaths, resulting in a case fatality rate of 15.3%. The total cost during the review period was \27,572,630, with a mean cost of \2,120,971 per patient. Conclusion: Ditch-related injuries are associated with a high rate of poor neurological outcome and pose a financial burden on the health insurance system. Injury prevention efforts directed at decreasing the risk of ditch-related falls are required to minimize these outcomes.