Motorcycle handlebar injuries in patient with "double ring sign" after a road traffic accident: A case report

Injuries caused by bicycle handlebars are often associated with the « ring sign », which is a major indicator of severe intra-abdominal injuries. The « double ring sign » in a patient with motorcycle handlebar injuries is rare. We report the case of a patient who was involved in a road traffic accident and suffered motorcycle handlebar injuries, in whom a "double ring sign" was observed. A 40 year-old male farmer, right-handed with a BMI of 23 Kg/m², was admitted in our facility after a road traffic accident. The main complaints were agitation, painful abdomen and pelvic. The diagnosis of hemoperitoneum associated with severe intra-abdominal injuries was made based on the patient's state of shock, generalized abdominal contracture, and the abdominal ring sign indicating intra-abdominal injuries related to the motorcycle handlebars. During a midline xyphopubic laparotomy, a traumatic abdominal wall hernia was observed, mesenteric tear, complete rupture of the small bowel as well as two intestinal wounds, and an hemorrhagic tear of the left iliopsoas muscle. The patient was fully treated in a category 4 rural hospital with a favorable outcome. Patients who have been involved in motorcycle accidents on public roads should be thoroughly examined for signs of ring-shaped or « double ring » bruising caused motorcycle handlebars, as the injuries underlying this symptom are usually severe.