A Case Report of Handlebar Hernia: The Importance of Identifying Abdominal Wall Injuries in Blunt Trauma

Introduction: Abdominal wall injuries following blunt trauma are uncommon and often overlooked clinically. We present a case of an occult injury subsequently complicated with herniated bowel.

Case presentation: A 68 y/o male presented to the emergency department after sustaining an abdominal impact from a bicycle handlebar. On physical examination mild bruises on the left lower abdomen were found, and a CT revealed a few tiny linear lesions suspected of lacerations in the left hepatic lobe, without hemoperitoneum, treated conservatively. Three days later, he returned to the ED with a tender swallowing in his left lower abdomen. A CT scan demonstrated herniated small bowel loops through a tear in the left external and internal oblique muscles. Retrospective review of the initial scan revealed a small laceration in these muscles.

Conclusion: Handlebar hernias should be suspected in significant blunt traumas, even with no obvious signs on physical examination.