When a handle bar accident leads to hernia: report of three cases

Blunt impact-induced traumatic abdominal wall hernia (TAWH) is classically associated with handlebar injury caused by direct trauma to the anterior abdominal wall, hence the term "handlebar hernia." It is uncommon in children and associated with significant morbidity if diagnosis is delayed. The aim of this study is to present our experience in treating bicycle handlebar-associated TAWH, highlight the likelihood of associated intra-abdominal injuries, and emphasize the importance of early imaging and surgical intervention when necessary.

Three cases of abdominal wall hernia were included. All patients were boys, with a mean age of 8.6 years (range: 7-11 years). All patients presented with swelling in the iliac fossa (right n= 2 and left n= 1). Emergency computed tomography (CT) was performed in all cases: two revealed a muscular defect, while the third showed pneumoperitoneum. The musculoaponeurotic defect was surgically repaired in each case. In the third patient, a small intestinal perforation was also identified and sutured. All patients recovered uneventfully.

TAWH is a rare clinical entity that may signal more significant associated injuries, such as hollow viscus perforation, which often requires urgent surgery. A high index of suspicion is necessary in children presenting with bruising, abrasions, ecchymosis, hematoma, or peritoneal signs following blunt abdominal trauma, and there should be a low threshold for additional imaging.