Diagnostic double strike in the emergency room - two cases of complete pancreatic ruptures due to bicycle handlebar injuries on two consecutive days

Abstract

BackgroundPancreatic injuries are rare in cases of blunt abdominal trauma and therefore easily misdiagnosed at time of hospital admission. They are associated with a significantly elevated morbidity and lethality. Bicycle handlebar injuries are the most common cause of pancreatic trauma in children and adolescents.Case presentationWe report two cases of a 23-year-old Caucasian woman and a 15-year-old Caucasian boy who presented to our clinic with a similar history of a bicycle accident on 2 consecutive days. Both suffered from a fall from a bicycle with bicycle handlebar injury 4 and 6 days prior to admission in our clinic. Emergency distal pancreatectomies were performed in both cases.ConclusionsPancreatic injuries must be highly suspected in bicycle handlebar injuries, even if amylase/lipase levels or ultrasound findings seem unremarkable. The best initial strategies are early computed tomography and a quick referral to a level 1 trauma center. Distal pancreatectomy is the treatment of choice in cases of complete rupture of the pancreatic body.

Solid pseudopapillary neoplasm of pancreas presenting after bicycle handlebar injury: diagnostic pitfalls in a young female-A case report

“…Pancreatic injuries are rare in blunt abdominal trauma (0.6%) and can easily be missed. In contrast, bicycle handlebar injury is the most common cause of pancreatic trauma in children and adolescents [4] . A missed pancreatic injury with partial ductal disruption may present late with an abdominal lump due to formation of pancreatic pseudocyst.…”

Bucket-handle mesenteric tear and traumatic abdominal wall hernia following bicycle handlebar injury in an adult: A ‘case report’

“…It is attributable to the infrequent and more careful use of a bicycle, and a strong-abdominal wall can prevent significant injury in adults compared to children. Though rare, bicycle handlebar blunt abdominal injuries can result in TAWH, BHMT, intestinal perforations, and pancreatic lacerations in adults [1] , [2] , [3] , [4] , [5] .…”

An Unusual Mountain Biking Injury: Case Records of the Massachusetts General Hospital Wilderness Medicine Fellowship

“…Handlebar injuries can include pancreatic injuries, traumatic abdominal wall hernias, duodenal hematoma, splenic and liver injuries, renal injuries, and rarely, vascular injuries. [4][5][6][7][8][9] Handlebar injuries are less common in adults, presumably because of well-developed abdominal wall musculature as well as the reduced likelihood of riding recklessly, in comparison to children and adolescents. 10 At this point, the patient requires evacuation and further evaluation.…”