Handlebar hernia: an uncommon cause of intra-abdominal lesions

A traumatic abdominal wall hernia (TAWH) is an uncommon complication of abdominal trauma. Handlebar hernia is an even rarer type of traumatic abdominal wall hernia, with only 33 previously reported cases in literature. It is caused by a local trauma with a handlebar-like object which is not sharp enough to penetrate the elastic skin, but has sufficient focused force to breach the muscle and fascia of the abdominal wall. A high index of clinical suspicion for associated intra-abdominal lesions in patients with traumatic abdominal wall hernia is warranted. This may not only influence the immediate treatment of the abdominal hernia but also the type and timing of mesh repair to be performed. Early repair is mandatory to avoid complications. The choice for primary repair versus mesh repair will be discussed according to the size of the hernia and the amount of tissue destruction by the trauma. The type of mesh used for the repair will be determined by presence or absence of contamination in the abdomen.