Handlebar Hernia with Triple Herniation and Perforation: A Case Report and Literature Review

Abstract

Blunt trauma abdomen is a very common entity but traumatic abdominal wall hernia is not that common. Herniation through abdominal wall usually occurs following trauma with seat belt, motor cycle, bicycle handle bar etc. Handlebar hernia is a less known variety of traumatic abdominal wall hernia as a consequence of injury with handlebar of a bicycle. It is difficult to diagnose and one should have high index of suspicion. Management in traumatic abdominal wall hernia is individualized based on various factors. We herein present an interesting case of a14-year-old boy, who sustained blunt trauma abdomen from bicycle handlebar leading to triple herniation and perforation of the small bowel and hematoma of the mesentery. Patient was resuscitated and operated with a favorable outcome. Blunt trauma abdomen is a very common and the possibility of traumatic abdominal wall hernia should always be borne in mind.

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

“…The most common site of occurrence of TAWH is in the lower abdomen. In a case report and literature review done in 2018, there were 80 cases of handlebar hernias, of which only 10 were adults with motorbike injury in 3, gear-poke car in 1, and bicycle injury in 6 patients [16] . In a case report and review of works of literature from Turkey done on adult bicycle handlebar hernia, they reported 10 cases of handlebar hernia, including their own [17] .…”

Traumatic inguinal hernia: An uncommonly reported entity

“…The most common aetiological factors for traumatic herniation include lowenergy trauma such as handlebar injury, bullhorn, sports and seatbelt injuries and high-energy trauma due to road-traffic accidents. 7 Three types of TAWHs are defined according to the mechanism of injury: type 1 TAWH that describes small hernia in the anterio-inferior abdominal wall and inguinal region caused by low-energy blunt trauma (e.g. handlebar injuries); type 2 TAWH that are large hernia defects caused by high-energy trauma such as road-traffic accidents; and type 3 TAWH that are rare variants seen in acute deceleration injuries.…”

“…Clinically, the appearance of a bulge or tender swelling on the abdominal wall with or without associated skin lesions after an incident of blunt trauma to the abdomen helps establish its traumatic origin, and in doubtful cases, a contrast-enhanced computed tomography scan of the abdomen is considered a valuable tool for early detection of traumatic hernias. 7,11 TAWH in itself can be a primary cause of death. It is recognised that delayed diagnosis of this condition can lead to bowel ischaemia/infarction, whilst it may also be associated with bowel perforation, both of which can prove fatal if untreated.…”

Traumatic Ventral Hypogastric Hernia: A Case Report and Review of Literature in Pediatrics

“…A MEDLINE search via PubMed and Cochrane Library using keywords "handlebar hernia" and "traumatic abdominal wall hernias" revealed about 79 case reports on handlebar hernias in both pediatrics and adults (Table 1) [17].…”