Handlebar Injury Research Articles

A 12‐year retrospective analysis of non‐operative management for paediatric duodenal hematomas caused by trauma at a single center

AbstractBackgroundPaediatric traumatic duodenal hematoma is a rare type of blunt abdominal injury for which treatment strategies are controversial. This study aimed to evaluate the application value of nonoperative management of paediatric duodenal hematoma caused by trauma.MethodsA retrospective analysis was conducted on patients with duodenal hematoma with a confirmed history of abdominal trauma admitted to our hospital between January 2010 and December 2022. General patient information, including age, sex, cause of injury, clinical manifestations, and treatment outcomes, was recorded.ResultsA total of 11 cases were included in this study, with 6 males and 5 females. School‐age children (≥6 years) accounted for 72.7% (8/11) of the cases. Bicycle handlebar injuries accounted for 63.6% (7/11) of cases. Among these cases, 5 (45.5%) were classified as American Association for the Surgery of Trauma grade I, while the remaining were classified as grade II. The median history time was 1 day (range: 2 h–12 days). All patients were successfully treated using non‐operative methods. The median time to oral feeding after injury was 17 days (range: 9–32 days). Oral feeding was initiated within 2 weeks in 2 patients (18.2%), within 3 weeks in 6 patients (54.5%), and within 4 weeks in 10 patients (90.9%).ConclusionPaediatric traumatic duodenal hematoma is more common in school‐aged children, mainly due to bicycle handlebar injuries. Nonoperative treatment is proven to be safe and effective, with duodenal obstruction symptoms typically resolving within 4 weeks.

Abdominal impacts of handlebar injuries in the PIPER child model: a prevention study.

Analysis of data from bicycle accidents reveals that handlebar impacts are a significant cause of injury, particularly among children. Despite existing safety regulations, such as helmet requirements, little attention is given to abdominal injuries. The aim of this study is to investigate the influence of handlebar ends on abdominal loading during bicycle crashes. This study delves into the impact of five different handlebar designs on abdominal injuries during bicycle crashes, using finite element simulations with detailed Human Body Models (HBMs) of a six-year-old child (PIPER child model, Version 0.99.0). Four impact locations were identified in the injury scenario, selected according to the anatomical location of the most commonly injured organs, liver, pancreas, spleen and abdomen. Grip design features, such as shape and rigidity, significantly influence injury outcomes. Grips designed specifically for children demonstrate superior performance in reducing abdominal loading and injury metrics compared to standard grips. The highest injury potential was seen in a damaged handlebar end. These findings underscore the importance of improved handlebar designs and standardized safety measures, especially for children. Implementation of such measures could mitigate the significant health and economic burden associated with handlebar-related injuries and enhance overall bicycle safety for children.

Easily missed pediatric handlebar injury.

A 12-year-old girl, who fell from her bicycle, presented to the emergency department with severe epigastric pain and vomiting. Physical examination revealed torso contusion with a circular handlebar bruise over the upper anterior abdomen (Fig. 1a). Focused assessment with sonography for trauma (FAST) revealed no obvious fluid accumulation. Laboratory tests indicated elevated serum amylase (252 U/L) and lipase (>400 U/L) levels. Therefore, intravenous contrast-enhanced computed tomography (CT) with oral water-soluble contrast medium was performed to assess for any internal traumatic injury.

Vascular handlebar syndrome with blunt injury of common femoral artery.

Vascular handlebar syndrome with blunt injury of the common femoral artery is a rare vascular trauma mechanism, with high possibility of being missed or delayed. We present two cases of vascular handlebar syndrome treated in our hospital and a systematic review of the literature using MEDLINE and SCOPUS databases. Literature review identified 20 similar cases. The median age of patients was 18 years, and in vast majority males in gender. In most cases, the common femoral artery injury was an intimal flap and lumen occlusion with intramural thrombosis followed by transection and intimal injury without occlusion or thrombosis. The median time between injury and diagnosis/treatment was half an hour. Clinical presentation ranged from asymptomatic to acute limb ischemia. The grade of acute ischemia was mostly Rutherford class I (n=14), while acute IIa (n=4), chronic ischemia (n=3), and no ischemia (n=1) were also noticed. The correct diagnosis was revealed by clinical examination only (n=1), or by the combination of clinical and imaging techniques including computed tomography angiography (n=7) and duplex ultrasonography (n=4) or both (n=10). Management of the handlebar trauma syndrome injuries was surgical in most cases. Outcome was favorable in all patients. Vascular handlebar syndrome is extremely rare and high suspicion is required for early diagnosis and definitive treatment, as the early management is effective and crucial for averting the devastating consequences. An individualized approach to the vascular trauma patient is to be applied with considerations taken to the age of the patient, the mechanism of the injury, the anatomy of the lesion, and symptomatology of the case.

Post-traumatic Synchronous Twin Inter-muscular Abdominal and Diaphragmatic Hernias: A Rare Presentation

Simultaneous occurrence of traumatic abdominal wall hernia (TAWH) and traumatic diaphragmatic hernia (TDH) is uncommon. Our report documents the rare delayed presentation of simultaneous occurrence of TAWH and TDH in a patient who sustained a bicycle handlebar injury as a consequence of the bicycle he was riding colliding with a motorbike in a road-traffic accident. Excellent outcome could be achieved in this patient with surgical repair without requiring the use of a mesh.

Internal drainage of pancreatic pseudocyst following abdominal blunt trauma

Pancreatic pseudocyst is a well-recognized complication of acute pancreatitis, chronic pancreatitis and pancreatic trauma. Pancreatic trauma is the most common cause among children cases. The aim of this study is to describe the clinical presentation and management of symptomatic pancreatic pseudocyst in a series of 2 children following abdominal blunt trauma treated in our institution between January 2021 to August 2021. This was single-centre case series from our institution that is a tertiary referral hospital from January to August 2021. There were two patients between age 8–11 that diagnosed with pancreatic pseudocyst after blunt abdominal trauma, both of them underwent open internal drainage, specifically cystojejunostomy. All of 2 patients had a history of blunt abdominal trauma due to bicycle handlebar injury. Epigastric pain and abdominal mass were the main complaints. Amylase and lipase serum level were elevated and imaging diagnostic reveal pancreatic pseudocyst. Open cystojejunostomy were performed and the patient discharged from the hospital on day 7 and day 11 post operative, respectively, without any complication. Pancreatic pseudocyst although rare in children, can lead to a significant morbidity if not properly diagnosed and treated. Open internal drainage is still the procedure of choice in our institution.

Solid pseudopapillary neoplasm of pancreas presenting after bicycle handlebar injury: diagnostic pitfalls in a young female-A case report.

Introduction and importanceSolid pseudopapillary neoplasm (SPN) of pancreas is a rare neoplasm with very low malignant potential. It mainly affects females in third decade of life and has favourable prognosis.Case presentationWe report a case where a 17-years old girl presented with history of blunt abdominal trauma with handlebar of bicycle 6 months back, following which she developed abdominal pain and fullness in epigastrium. Keeping pancreatic pseudocyst as provisional diagnosis, she was investigated. The final diagnosis of SPN of pancreas came as a surprise.The mass, about 6x5cm, was excised and Roux-en-Y distal pancreatico-jejunostomy was done.Clinical discussionPatient showed no recurrence or metastasis till one year of follow-up. This is the first case report of SPN presenting after handlebar injury.ConclusionTimely and adequate resection provides good long-term survival.

Bicycle Handlebar Injuries in Children During the COVID -19 Pandemic

Bicycle Handlebar Injuries in Children During the COVID -19 Pandemic

Bicycle handlebar injuries - a systematic review of pediatric chest and abdominal injuries.

The severity of handlebar injuries can be overlooked due to subtle signs and wide range of associated internal injuries. Our objective was to describe thoracoabdominal injuries due to bicycle handlebars and their outcomes in children. Articles that reported thoracoabdominal injuries were identified from database conception to March 3, 2019 using PubMed, EMBASE, Cochrane Library, CINHAHL Complete, Web of Science and Scopus. A systematic review of studies of thoracoabdominal handlebar injuries in children ≤21years on human-powered bicycles in English was performed. Information on demographics, clinical features, injuries, interventions and outcomes was noted. A total of 138 articles were identified from 1952 to 2019. There were 1072 children (males, 85.1%) and 1255 thoracoabdominal injuries. Mean age was 9.7±3.3years old. Common clinical features included abdominal pain and guarding, vomiting, fever and a handlebar imprint. The liver was the most frequently injured organ. Surgery was performed in 338 children with a mean age of 10.0±3.3years. Twenty-seven children (2.5%) were discharged and returned due to worsening symptoms, of whom 23 (85.2%) required surgery. Thirty-one children (2.9%) transferred to a higher level of care due to injury severity. Two deaths were reported. Bicycle handlebars can cause significant thoracoabdominal injuries. Presence of abdominal pain, vomiting, fever or a circular imprint on the chest or abdomen should prompt further workup. Future studies on diagnostic modalities and best practices are needed to lower the chance of missed injuries.

Endoscopic ultrasound-guided pancreatic drainage for treating a traumatic main pancreatic duct injury in a child

Abstract A 10-year-old Japanese boy presented the day after a bicycle handlebar injury with mild abdominal pain. Computed tomography (CT) confirmed pancreatic transection and possible main pancreatic duct (MPD) injury because of a fluid collection around the pancreas. Conservative management (fasting, antibiotics, total parental nutrition, protease inhibitor) was initially successful, but an oral challenge with plain water on day 23 caused a relapse. CT identified a pancreatic pseudocyst. Endoscopic trans-papillary drainage was attempted but failed because the MPD was completely obstructed. Endoscopic ultrasound (EUS)-guided drainage of the pseudocyst with a lumen apposing metal stent (LAMS) was performed on day 29 via the stomach. On day 36, EUS-guided pancreatic drainage (EUS-PD) with a 5Fr plastic stent was performed via the stomach with rapid improvement in symptoms and elevated enzyme levels. Repeat oral challenge on day 39 was successful, the LAMS was removed on day 59 without recurrence. He was discharged well on day 69 and remains asymptomatic 20 months after treatment. Our case highlights the potential of minimally invasive endoscopic procedures as options for the non-surgical management of complete MPD disruption in a child. However, further research to develop dedicated pediatric endoscopic devices is required.

Traumatic Abdominal Wall Hernia in Children: A Systematic Review

BackgroundTraumatic abdominal wall hernia (TAWH) in children is an uncommon injury and most commonly occurs after blunt abdominal trauma. There is no consensus on the management of these rare cases. We performed a systematic review of the literature to describe injuries, management, and outcomes. Materials and methodsFollowing Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, a systematic literature search of PubMed, Web of Science, Embase, and Google Scholar was performed to identify English-language publications of blunt TAWH in patients <18 y old. Conflicts were resolved by consensus. Data were collected on demographics, associated injuries, management, and outcomes. ResultsA total of 71 articles were reviewed with 100 cases of TAWH. A total of 82.5% of patients were male, and the median age was 9 y old (range 2-15). Injury by bicycle handlebars was most common (72%) followed by motor vehicle collision (14%). Forty patients had intraabdominal injuries, most commonly bowel (70%) or mesentery (37.5%). Rate of intraabdominal injury was significantly higher in patients with injuries due to nonbicycle handlebar injuries when compared with bicycle handlebar injuries (60.7% versus 33.3%, P = 0.02). Most patients were managed operatively (85%), most commonly via laparotomy (68/85, 80%), with six laparoscopic repairs and five laparoscopic converted to open repairs. There were three reported complications and no recurrences over a median of follow-up of 5 mo in patients who underwent repair. ConclusionsPediatric TAWH is a rare injury with a high rate of intraabdominal injuries, particularly when due to high-impact mechanisms such as motor vehicle collision. Although open repair is more commonly performed, laparoscopic repair has been described with success. Recurrence rates appear low, but follow-up has been short term.

Pediatric traumatic abdominal wall hernia as a component of the seatbelt syndrome: a case series and review of the literature.

Blunt impact-induced traumatic abdominal wall hernia (TAWH) is an uncommon pediatric surgical problem classically associated with handlebar injury but increasingly seen with seatbelt use in motor vehicle collisions (MVC). Herein we describe the largest case series of pediatric TAWH to date and review the literature to establish the unique syndromic characteristics of MVC-associated TAWH. In this single-institution series, we discuss four pediatric patients, all with seatbelt-associated TAWH after high-speed MVC characterized by full-thickness disruption of the lateral abdominal wall. We then performed a review of the literature to identify additional pediatric MVC-associated TAWH and define the characteristics of patients who sustained this unique injury. In addition to the four patients in our case series, five additional pediatric patients presenting with TAWH after restrained MVC were identified in the literature. Of these nine patients, eight (89%) presented with an obvious seatbelt sign (bruising/laceration to the abdominal wall). Six (67%) had associated injuries typical of the seatbelt syndrome, including four spinal flexion injuries (44%) and five bowel injuries requiring repair or resection (56%). Overall, 56% of seatbelt-associated TAWH occurred in children with a BMI percentile > 95%. In this case series and literature review, we note a high rate of seatbelt syndrome injuries in pediatric patients presenting with TAWH after restrained MVC. Suspicion for TAWH should be high in children presenting with a seatbelt sign and should trigger a low threshold for pursuing additional axial imaging. Level IV; case series.

Traumatic duodenal injuries in children: a single-centre study.

Traumatic duodenal injuries in children are rare, and few studies have documented duodenal injuries in children, especially in Australasia. This study assessed the mechanism, investigations, management and outcomes of children (aged <16 years) with duodenal injuries. Retrospective review was conducted over a 16-year period from a single paediatric trauma centre. Sixteen cases of duodenal injuries were identified: 15 cases of blunt duodenal injury and only one case of penetrating injury. Motor vehicular accidents were the most common cause of injury, followed by auto-pedestrian injuries and handlebar injuries. Only grade I and II injuries were identified. Computed tomography aided diagnosis in all cases of blunt duodenal injuries, especially given the variable nature of symptoms. Eight patients underwent laparotomy, of whom five required duodenal repair. Three patients underwent primary repair with omental patch, one patient underwent primary repair with gastrostomy and one patient underwent two-layered repair with t-tube duodenostomy. There were no delays in operative management within 24 h and no complications identified. In comparison to other paediatric trauma centres worldwide, the majority of duodenal injuries were low grade and attributed to blunt trauma. Computed tomography aided diagnosis in all cases of blunt duodenal injury. Primary repair of duodenal injuries was possible in the majority of cases requiring operative repair.

Trauma abdominal contuso por golpe con manubrio de bicicleta

Introducción: Los accidentes en bicicleta son una causa frecuente de trauma abdominal contuso en pediatría. En Chile no existen publicaciones científicas que traten sobre las lesiones abdominales por manubrio de bicicleta, su presentación y manejo.Objetivo: Describir tres casos clínicos de trauma abdominal contuso provocados por manubrio de bicicleta en niños, ilustrar las distintas lesiones observadas, sus formas de presentación y manejo.Casos Clínicos: 1) Paciente masculino, 11 años, consulta tras golpe con manubrio de bicicleta en epigastrio; en la Tomografía Computada (TC) de abdomen y pelvis se describió neumoretroperitoneo. Se realizó laparotomía exploradora, reparándose una perforación duodenal. 2) Paciente masculino, 14 años, consulta tras golpe en el hipocondrio izquierdo con el manubrio de la bicicleta; en la TC se evidenció fractura esplénica con múltiples laceraciones. Por la presencia de sangrado activo se trató con angioembolización, lográndose resolución de la lesión y viabilidad del órgano luego de 6 semanas de seguimiento. 3) Paciente masculino, 9 años, ingresó tras sufrir golpe con manubrio de bicicleta en el hipocondrio derecho. En TC se observó una laceración hepática, que fue manejada de forma expectante, con resolución de la lesión luego de 8 semanas de seguimiento. Todos los pacientes tuvieron una evolución favorable.Conclusión: El trauma abdominal contuso por golpe con manubrio de bicicleta puede ser potencialmente grave en pacientes pediátricos, pudiendo afectar órganos sólidos y vísceras huecas. El manejo no quirúrgico cada vez es más utilizado, logrando altas tasas de éxito en pacientes estables. Los pacientes inestables o en los que se sospeche perforación de víscera hueca, requerirán cirugía como primera aproximación.

Abiotrophia defectiva liver abscess in a teenage boy after a supposedly mild blunt abdominal trauma: a case report

BackgroundA pyogenic liver abscess (PLA) represents a pus-filled cavity within the liver parenchyma caused by the invasion and multiplication of bacteria. The most common offender isolated from the PLA in children is Staphylococcus aureus. Abiotrophia defectiva is a Gram-positive pleomorphic bacterium, commonly found in the oral cavity, intestinal, and genitourinary mucosa as part of the normal microbiota. It has been proven to be an etiological factor in various infections, but rarely in cases of PLA. The case presented here is, to the best of our knowledge, the first pediatric case of PLA caused by A. defectiva.Case presentationA 13-year-old Caucasian boy presented with a two-day history of abdominal pain, fever up to 40 °C, and polyuria. Contrast-enhanced computed tomography (CT) scan revealed a single, multiloculated liver lesion, suggestive of a liver abscess. The boy had sustained a bicycle handlebar injury to his upper abdomen 3 weeks before the symptoms appeared and had been completely asymptomatic until 2 days before admission. He was successfully treated with antibiotic therapy and open surgical drainage. A. defectiva was isolated from the abscess material. Histopathology report described the lesion as a chronic PLA.ConclusionsA. defectiva is a highly uncommon cause of liver abscess in children. In such cases, various predisposing factors should be considered, including antecedent blunt abdominal trauma.

Clinical Image - Unexplained Intraluminal Contrast In A Trauma Patient

A 22-year-old male presented from the scene as a trauma after motorcycle crash. He was tachycardic and hypertensive with obvious extremity injuries and a circular handlebar injury to the midabdomen. He underwent CT scan with intravenous contrast. CT revealed free intraperitoneal air with intraluminal high-density material consistent with contrast in the small and large bowel.

Traumatic abdominal wall hernia

Abstract Traumatic abdominal wall hernia (TAWH) is uncommon in children and most cases are related to handle bar injury. We report a case of TAWH and pelvic fracture following road traffic accident at an unusual site. Part of the transverse colon, along with its mesocolon, was herniated into a defect in the wall of left lower chest and of left upper quadrant of abdomen. Laparotomy was done and the hernial defect was repaired.

SAT-184 Silent Pheochromocytoma Complicated by Adrenal Insufficiency After Unilateral Adrenalectomy

Background: Adrenal insufficiency (AI) following unilateral adrenalectomy for pheochromocytoma (PCC) is an exceedingly rare occurrence described previously in 1 study in only 4 out of 13 patients with unilateral PCC. We discuss an unusual case of a patient with incidentally discovered PCC who underwent unilateral adrenalectomy and subsequently developed AI. Clinical Case: 61-year-old male in overall good health taking no medications presented with left flank and groin pain after a handlebar injury in a bicycle crash. CT angiogram Abdomen & Pelvis revealed a complex enhancing left adrenal mass with internal necrosis measuring 13 x 12 cm. He denied history of headaches, diaphoresis, chest pain or hypertensive crisis. He did endorse palpitations which had resolved with reduced caffeine intake. Labs showed plasma free metanephrine 3,295 pg/mL (ref range <57) and normetanephrine 68,472 pg/mL (<148), 24hr urine metanephrine 192,677 ug (52-341), 24hr urine normetanephrine 171,880 ug (88-444), 24hr urine vanillylmandelic acid (VMA) 182 mg (1.8-6.7), serum aldosterone 8.1 ng/dL (<39.2), serum free cortisol 0.47 ug/dL (0.07-0.93), 24hr urine cortisol 41.6 ug (<60), DHEA sulfate 37 ug/dL (42-290). He was started on phenoxybenzamine and underwent left adrenalectomy. Of note patient remained only minimally hypertensive with tumor manipulation intraoperatively. Pathology was consistent with PCC with no evidence of regional or distant metastases. Postop-labs showed plasma free metanephrine <25 pg/mL and normetanephrine 122 pg/mL. Calcitonin and parathyroid hormone levels were normal. Patient was evaluated in endocrinology clinic 4 weeks after surgery for complaint of severe fatigue, weight loss, anorexia and myalgias. Adrenocorticotropic hormone (ACTH) level was 31 pg/mL (7.2-63) with AM cortisol of 2.1 ug/dL (5-23) which increased to 7.4 ug/dL 1 hour after Cosyntoprin 250 mcg stimulation. He was started on prednisone 10 mg once daily with significant improvement in his symptoms. Conclusion: PCCs typically manifest as sustained or paroxysmal hypertension, episodic headaches, palpitations or diaphoresis. Our patient was found to have a PCC with strikingly elevated levels of catecholamines without typical signs and symptoms of PCC. To the best of our knowledge this is the 5th reported case where a patient developed AI after unilateral adrenalectomy for PCC. There are case reports describing PCCs which secrete both catecholamines and ACTH. However, our patient lacked clinical or biochemical evidence of hypercortisolism preoperatively and his tumor cells in path sample stained negative for ACTH. Other possible pathophysiologic mechanisms include ectopic corticotropin releasing factor production leading to subclinical Cushing syndrome (SCS). Clinicians should have a high suspicion for SCS in the setting of PCC to promptly diagnose and treat AI after unilateral adrenalectomy.

CT Findings of Pediatric Handlebar Injuries.

Direct bicycle handlebar injuries are a significant cause of chest and abdominal trauma and morbidity in the pediatric population. However, these injuries have been underemphasized. While blunt abdominal trauma has been described well, the literature is limited in reviewing trauma imaging specifically related to direct handlebar injuries in the pediatric population. Major chest injuries include lung contusions, pneumatoceles, and pneumothorax. In the abdomen, injuries to the pancreas, small bowel, mesentery, liver, and spleen are the more common abdominal injuries attributed to direct handlebar trauma. Traumatic abdominal wall hernias and groin injuries, which may be associated with vascular injuries, are other known injuries. The challenge is in both clinical and radiographic diagnosis. The physical findings are often underwhelming, and laboratory values in many studies are shown to be not very sensitive or specific. As a result, there is a risk of delay in imaging, diagnosis, and treatment of significant and sometimes life-threatening injuries. CT is considered the standard examination to delineate intra-abdominal trauma, with a reported sensitivity of 60%-88% and a specificity of 97%-99%. Moreover, CT helps in grading some types of injury and helps guide the surgical treatment course. It is important for radiologists who perform imaging in adults and children to be aware of the significance of direct handlebar injuries and their imaging findings. ©RSNA, 2020.

Traumatic rupture of Meckel's diverticulum secondary to handle bar injury

Traumatic rupture of Meckel's diverticulum secondary to handle bar injury