Traumatic handlebar hernia: a rare abdominal wall hernia.

Traumatic abdominal wall herniation (TAWH) caused by direct trauma from bicycle handlebars are rare. There are only 21 reported cases of handlebar hernias. An 11-year-old boy presented to the emergency room soon after falling from his bicycle and hitting his right lower quadrant on the handlebars. The patient's vital signs and initial laboratory studies were normal. Physical exam showed a soft tissue bulge in the right lower quadrant with superficial ecchymosis and tenderness to palpation. Computed tomography showed intestinal loops protruding through a defect in the abdominal wall into the subcutaneous space. Surgical exploration found a defect throughout his entire abdominal wall including the fascia, muscular layers, and peritoneum, with bowel protruding into the subcutaneous space. The defect was repaired in layers, and the child's postoperative course was unevenful. The authors recommend a high level of clinical suspicion for TAWH in all patients with traumatic abdominal wall injuries. Definitive treatment includes surgical exploration with primary repair of all tissue layers of the abdominal wall.