Handlebar Hernia in Children: Two Cases and Review of the Literature

Arias, M. Prada; Carbonell, Teresa Dargallo; Martínez, E. Estévez; Casasnovas, Adolfo Bautista; Cives, R. Varela

doi:10.1055/s-2004-815863

Cited by 18 publications

(14 citation statements)

References 11 publications

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“…The spectrum of injuries we encountered (Table 1) is comparable to other studies in pediatric patients where parenchymatous organ lesions were found in up to 30 %, intestinal perforations in up to 10 % [13,14], and traumatic abdominal wall hernia in up to 20 % [15] and are also described in adults [16]. Traumatic thoracic wall hernias are very rare [17,18].…”

Section: Discussionsupporting

confidence: 85%

Handlebar injuries in children

et al. 2012

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Introduction Handlebar injuries in children may lead to severe organ lesions despite minimal initial signs and without visible skin bruise. We present our experiences applying a diagnostic and therapeutic algorithm for blunt abdominal trauma, and present the history of two selected cases. Materials and methods We retrospectively assessed the charts of children below 16 years of age, only who were observed for 24 h or more in our institution due to a handlebar injury between 2004 and 2011. All children were treated according to an institutional algorithm. Results 40 patients with a median age of 9.5 years were included. Diagnosed lesions were: ruptures of the liver (n = 6), spleen (n = 5), kidney (n = 1), and pancreas (n = 2), small bowel perforation (n = 3), and hernias of the abdominal (n = 2) or thoracic wall (n = 1). Surgical interventions were performed in 8 patients. The outcome was favorable in all the cases. Overall median hospitalization duration was 4.5 days (range 1-19 days). The overall duration between the accident and arrival at our emergency unit was 2.75 h (median, range 1-19 h). 20 children presented directly at our emergency unit after a median of 1.7 h (range 1-19.5 h). 20 children were referred by a family physician or a primary hospital after a median of 4.0 h (range 1-46 h). ConclusionHandlebar injuries in children resulted in serious trunk lesions in half of the present patient series. The spectrum of injuries in handlebar accidents varies widely, especially injuries to the abdomen can unmask often only in the course. We advocate close observation of patients with thoracic and abdominal handlebar injuries which may be regarded as blunt stab wounds. An institutional algorithm for blunt abdominal trauma management is supportive for emergency care in patients with handlebar injuries.

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Section: Discussionsupporting

confidence: 85%

Handlebar injuries in children

et al. 2012

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“…Computed tomography and US were useful for detecting the disruption of the abdominal wall musculature or the prolapsed intestine. [1][2][3][4][5][6][7][8][9][10][11] In our patient, no prolapsed bowel was found, but a disruption of the abdominal wall musculature was clearly seen on the CT scan. If the disruption of abdominal wall muscles is unclear, local dilated intestinal loops might indicate intestinal obstruction or herniation into the abdominal wall.…”

Section: Case Reportmentioning

confidence: 55%

“…The handlebar hernia of our patient resolved within 3 weeks with an abdominal bandage; however, because a case of delayed appearance of TAWH was reported, careful follow-up is important. 6,13,14 In conclusion, the possibility of handlebar hernia should always be considered in children who have suffered abdominal trauma in a bicycle accident.…”

Section: Discussionmentioning

confidence: 99%

“…1,5,9 Only about 30 cases of handlebar hernia have been reported in the English literature. [1][2][3][4][5][6][7][8][9][10][11] More than 80% of TAWHs are caused by lower energy trauma as a result of bicycle-handlebar injuries. 9 It is noteworthy that this type of injury is infrequently associated with other organ injuries.…”

Section: Case Reportmentioning

confidence: 99%

“…In most reported cases, surgical repair was performed immediately. [1][2][3][4][5][6][7][8][9][10] We report a case of handlebar hernia managed conservatively with excellent results.…”

Section: Introductionmentioning

confidence: 99%

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Successful Conservative Treatment of a Bicycle-Handlebar Hernia: Report of a Case

Matsuo¹,

Okada²,

Murakami³

2007

Surg Today

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Handlebar hernia is a rare type of blunt traumatic abdominal wall hernia (TAWH). It involves a disruption of the abdominal wall muscles, with bowel loop herniation through the defect in the abdominal wall. We report a case of bicycle-handlebar hernia in a 9-year-old boy who had all layers of his abdominal wall disrupted after falling from his bicycle. He was brought to our hospital with lower abdominal pain and bulging. A physical examination revealed left lower quadrant bulging in a standing posture, and a palpable fascial defect, 3 cm in diameter. Computed tomography showed a disruption of the abdominal rectal muscle layer, but his skin and intra-abdominal organs were completely intact. The patient was treated conservatively with abdominal wall compression using a cotton cloth corset. Within 3 weeks, his abdominal wall hernia had healed without the need for any surgical intervention.

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