Bicycle handlebar hernia with multiple enterotomies: a case report

Abstract

Background: Bicycle handlebar hernias are uncommon form of traumatic abdominal wall hernias (TAWH) resulting from a direct blunt trauma to the anterior abdominal wall.

Case presentation: This report describes a 14 year-old boy with no history of previous abdominal hernia, presented in the emergency department with an isolated, tender lump in his right iliac fossa after falling off his bicycle. Contrast Enhanced Computer Tomography (CE-CT) showed intestinal loops protruding through the abdominal wall defect with free air in peritoneum suggesting hollow viscus perforation. He underwent emergency laparotomy through transverse skin incision, which showed mid jejunum mesentery tear and multiple enterotomies. A wedge small bowel resection of enterotomies with primary closure, repair of mesenteric tear followed by a primary repair of the abdominal wall hernia was performed. The patient made an uneventful post-operative recovery.

Conclusion: Bicycle handlebar Hernia (BHH) is a type of traumatic abdominal wall hernia caused by a low impact energy direct blunt injury. We describe a case of BHH associated with small bowel injury which was treated with exploratory laparotomy through skin crease traverse incision. This surgical approach allowed an appropriate exploration of all the intrabdominal structures and primary repair of the hernial defect.