Handlebar hernias represent distinct type of traumatic abdominal wall hernia (TAWH) caused by a focal, low-velocity blunt force. Such injuries may remain undetected initially and may subsequently result in incarceration or strangulation. A 9-year-old boy presented with a reducible lower abdominal swelling and mild localized discomfort two days after sustaining a bicycle handlebar injury. Initial ultrasonography (USG) was unremarkable. Examination revealed a palpable fascial defect in the left iliac fossa. Repeat USG demonstrated an infra-umbilical abdominal wall defect containing omentum. Contrast- Enhanced Computed Tomography (CECT) confirmed a musculo-fascial defect of size 2×2.8-cm in the left linea semilunaris without associated intra-abdominal injury. The child remained hemodynamically stable, tolerated oral feeds, and had no signs of bowel obstruction or incarceration. Elective surgical repair was undertaken. Intraoperatively, the defect was partially plugged by omentum and repaired primarily with absorbable, 2-0 polyglactin sutures. The post-operative course was uneventful. The patient was discharged within 24 hours postoperatively and remained asymptomatic at follow-up. Patients who sustain a handlebar injury should be evaluated for possible disruption of the abdominal wall muscles even in the absence of a skin defect.
Kotte et al. (Sun,) studied this question.