Handlebar Traumatic Injury
Young girl presents to you after low energy, helmeted bicycle accident. Her vitals are normal for age, but she is moderately tender to her abdomen and lower costal region. No guarding/peritoneal signs. But you astutely recognize a subtle danger that needs to be teased out. After little improvement with tylenol and short obs period w/ re-exams (normal CXR and pelvis exam), her abdomen remains tender. She is sent to CT abd w/contrast ---> sent to OR for surgical intervention.
HANDLE BAR INJURIES: classic presentation with concern for blunt abdominal trauma --> specifically splenic lacs/rupture.
Severe abdominal injuries related to bicycles occur, in over 80% of cases according to some studies, under unremarkable circumstances consisting in falling from a low altitude with consequent stabbing with the blunt handlebar. Common injuries to spleen, liver, pancreas. Can have intestinal trauma too.
EXAM: can range from subtle findings to peritonitis and hemorrhagic shock. May have vital signs instability, but more common early presentations can be less alarming at first. Obs time and multiple abdominal exams, FASTs and repeat imaging may be needed.
SIGNS: (alluding to intestinal trauma with hemorrhage ; either solid organ or retroperitoneal)
1. CULLENS SIGN --> periumbilical ecchymosis (bruising)
2. GREY TURNER SIGN--> flank ecchymosis
BOTTOM LINE: Handlebar injuries are frequently underestimated and injuries to the small bowel can be overlooked. These instances can lead to missed and/or delayed diagnosis and intervention. Keep this injury pattern on your differential and seek further imaging, consultation, evaluation when concerned!
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