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Case report
Handlebar sign: a bruise with underlying visceral injury
  1. Vijay Waman Dhakre,
  2. Sarvesh B Kadam,
  3. Akhilesh Gowda and
  4. Sandhya Iyer
  1. Department of General Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
  1. Correspondence to Dr Vijay Waman Dhakre; vddrvijayd{at}gmail.com

Abstract

A 14-year-old boy presented with a painful swelling topped by a bruise overlying the skin of the right inguinal region without peritonitis. This was the area of impact of bicycle handlebar while riding 6 days ago. On contrast-enhanced CT scan, we found a traumatic abdominal wall hernia (handlebar hernia) near the right deep ring without any solid organ, bowel or urinary bladder injury. Inguinal exploration revealed a defect in transversus abdominis and internal oblique muscle which was repaired and meshplasty was done.

Delayed presentation and ignorance towards ‘handlebar sign’ is associated with visceral injury (haematoma/perforation) will incur the risk of rising morbidity and mortality. With CT scan we can assess the abdominal cavity to rule out associated visceral or vascular injury. Surgical repair for restoring disrupted anatomy with or without meshplasty is the preferred approach.

  • trauma
  • accidents, injuries
  • radiology
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Footnotes

  • Contributors VWD has operated this case and designed the discussion and contributed to proofreading. SBK has assisted the operation and wrote the case presentation and procured the images. AG has assisted this surgery and contributed in designing the article and contributed in formulating discussion. SI has checked and contributed to the literature search and finalised the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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