A concealed small bowel perforation in an adult secondary to bicycle handlebar trauma

Abstract

Traumatic abdominal wall hernia (TAWH) secondary to bicycle handlebar is a rare injury. The majority of the literature describes abdominal wall herniation in children. We present a rare case of TAWH in an adult with a concealed small bowel perforation. Although clinical examination in conjunction with computed tomography can exclude the majority of solid organ injuries, small bowel injuries can often be missed. Our case initially revealed a serosal tear in the small bowel but, on close inspection, a separate 3mm perforation was identified, hidden in the small bowel mesentery. We strongly support a low threshold for operative intervention if there is any suspicion. Moreover, we stress the importance of meticulous examination during laparotomy as this injury could have been easily missed, resulting in potential morbidity or mortality in a patient sustaining such an injury.

Figure 1

Figure 1 A partial, full thickness tear of the mesentery (A) and 10mm serosal tear on the antimesenteric border of the midileum (B). The dotted oval is the position where the third injury was later identified. (See Fig 2.)

Figure 2

A 3mm full thickness perforation, concealed in the mesentery of the small bowel (C)