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

Abstract

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.

Conservative management of a traumatic abdominal wall hernia after a bicycle handlebar injury (case report and literature review)

“…In another, TAWH could not be identified by CT and was only evident through exploratory laparoscopy [11]. Surgical repair of the hernia was carried out in 31 cases, with only one case being successfully treated conservatively [7]. In this case, CT scan confirmed laceration of the abdominal rectal muscles, and a cotton corset was used for abdominal compression, on the understanding that if this was unsuccessful, he would proceed to surgery.…”

“…A CT scan [5,7,8] and/or ultrasound [4,6,9] have been used in assessing the injury and identifying the defect in the anterior abdominal wall. In 2 patients, surgery was based on clinical diagnosis only [2,3].…”

“…Thirty-two cases of bicycle handlebar hernia have been reported previously in children [1][2][3][4][5][6][7][8][9][10][11]. In one case [6], the hernia was not detectable in the first 48 hours either by ultrasound scan or clinical examination but was apparent clinically on review 12 days after injury and was then detected by ultrasound.…”

“…For this reason, it has been referred to as "handlebar hernia" [1]. These have been reported in both children and adults [1][2][3][4][5][6][7][8][9][10][11]. The first reported case of TAWH in a child was in 1906 by Selby [1], who reported a hernia because of impact against the handle of a wheelbarrow.…”

A hidden danger of childhood trauma: Bicycle handlebar injuries

“…The general aim of surgery for TAWH is to repair the abdominal wall hernia; however, spontaneous recovery of the defect with a conservative approach has also been reported. 8 The fi rst patient had a 4 × 2-cm fascia defect in the left lower quadrant, which protruded when the patient was standing up and the hernia content could easily be reduced. The patient had no concurrent intra-abdominal pathology and a conservative approach was decided on with a surgical option if required.…”