Handlebar Hernia

Dimyan, WafikA.; Robb, J. V. M.; MacKay, C

doi:10.1097/00005373-198009000-00020

Cited by 53 publications

(41 citation statements)

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“…A traumatic abdominal wall hernia caused by handlebars was reported by Dimyan et al in 1980 [2]. It is generally produced by a discrete point of energy transfer such as a handlebar or any other unyielding object, blunt enough not to penetrate the skin, but small enough for the force to be localized.…”

Section: Discussionmentioning

confidence: 99%

Handlebar hernia: traumatic abdominal wall hernia with multiple enterotomies. A case report and review of the literature

Haimovici

Papafragkou

Kessler

et al. 2007

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 99%

Handlebar hernia: traumatic abdominal wall hernia with multiple enterotomies. A case report and review of the literature

Haimovici

Papafragkou

Kessler

et al. 2007

Journal of Pediatric Surgery

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“…4 In 1980 Dimyan et al developed the term 'handlebar hernia' as a result of direct blunt trauma against a motorcycle handlebar during a head-on collision. 5 Wood et al characterised TAWH into three types: small defects as a result of blunt trauma, larger defects sustained by high energy transfer such as motor vehicle accidents and intra-abdominal bowel herniation as a result of a deceleration injury. 6 The force sustained from blunt injury does not penetrate the abdomen because of the elastic properties of the skin.…”

Section: Discussionmentioning

confidence: 99%

“…However, the increased abdominal pressure due to direct impact results in energy dissipation through the abdominal wall, leading to shearing of fascial and muscle layers. 5 The most likely cause of a small bowel injury in such cases is a crush injury between the handlebar and vertebral spine.…”

Section: Discussionmentioning

confidence: 99%

A concealed small bowel perforation in an adult secondary to bicycle handlebar trauma

Ghosh

Nolan

Simpson

2013

annals

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Traumatic abdominal wall hernia (TAWH) secondary to bicycle handlebar is a rare injury. The majority of the literature describes abdominal wall herniation in children. We present a rare case of TAWH in an adult with a concealed small bowel perforation. Although clinical examination in conjunction with computed tomography can exclude the majority of solid organ injuries, small bowel injuries can often be missed. Our case initially revealed a serosal tear in the small bowel but, on close inspection, a separate 3mm perforation was identified, hidden in the small bowel mesentery. We strongly support a low threshold for operative intervention if there is any suspicion. Moreover, we stress the importance of meticulous examination during laparotomy as this injury could have been easily missed, resulting in potential morbidity or mortality in a patient sustaining such an injury. KEYWORDSTraumatic abdominal wall hernia -Bicycle handlebar injury -Small bowel perforation Traumatic abdominal wall hernia (TAWH) secondary to a bicycle handlebar is a rare injury. Many of the published cases have been identified in children. One recent literature review identified 21 cases of TAWH as a result of bicycle handlebar trauma in children between the ages of 4 and 14 years. However, there were no intra-abdominal findings of small bowel injury, and all cases were managed with laparotomy and layered closure. 1 Haimovici et al described the first case of an incarcerated handlebar hernia associated with multiple jejunal perforations and mesenteric tears in a 15-year-old boy.2 Karaman et al reported two cases of antimesenteric ileal perforations in 14 children over a 3-year period.3 To the best of our knowledge, we present the first adult case of a concealed bowel perforation in the mesenteric border of the midileum. Case historyA 25-year-old man with no past medical history or any preexisting abdominal wall hernias was pedalling a bicycle on an incline when his chain derailed. This caused him to fall on to the handlebars, resulting in a blunt trauma injury to his abdomen. He was complaining of severe abdominal pain and a mass in the lower abdomen. His vital signs were unremarkable.Abdominal examination demonstrated a 10cm x 5cm diffusely tender, non-reducible swelling in the infraumbilical region, associated with a ring-shaped ecchymosis caused by the bicycle handlebar end. Computed tomography showed a 12mm tear in the rectus sheath, inferior to the umbilicus, containing small bowel loops in the subcutaneous tissue. There was no intra-abdominal free air or fluid.A lower midline laparotomy was performed. Small bowel loops were visible in the subcutaneous fat. There was a bilateral transverse tear in the rectus sheath with separation of rectus muscle in the midline. Omentum and small bowel mesentery were also protruding through the ruptured peritoneum.On examination of the small bowel, two injuries were identified initially (Fig 1). There was a partial, full thickness tear of the mesentery and a 10mm serosal tear on the antimesenter...

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“…7 In 1980, Dimyan et al applied the term handlebar hernia to describe a patient who was thrown against the handlebar of the motorcycle in a head-on collision with a motorcar. 2 A number of classification schemes for traumatic herniae based on size of defect, severity of injury and location, and mechanism of injury have been proposed. 4,8,11,12 Traumatic herniae produced by handlebar injuries are caused by sudden localised impact against a small blunt object.…”

Section: Discussionmentioning

confidence: 99%