Case Report Global Surgery Glob Surg, 2015 doi: 10.15761/GOS.1000119 Volume 1(3): 59-60 ISSN: 2056-7863 Traumatic handlebar hernia: case report of rare type of abdominal wall hernia Mohamedsuror Baderalmaarif 1 , Faisal A. Nugud 1 and Awad Ali M. Alawad 2 * 1 Department of Surgery, Faculty of Medicine, University of Gezira, Sudan 2 Department of Surgery, Faculty of Medicine, University of Medical Sciences and Technology, Sudan Abstract Acute Handlebar hernia is a rare type of hernia which might be a source of anxiety to the family as well as it could be associated with serious abdominal injuries. Here we reported a case of this type. He is a boy of 3 years presented to emergency department after sustaining a blunt abdominal trauma by a handlebar. Te fnal diagnosis was confrmed using U/S and surgical treatment was achieved. Introduction Traumatic abdominal wall hernia is a rare clinical entity despite the high incidence of blunt abdominal trauma. Te frst reported case was in 1906. Few cases were reported in the literature [1]. Handlebar hernias, which are localized defects, are even more infrequent. Only 42 cases reported from September 1977 to November 2010 [2]. It involves disruption of the abdominal wall muscles, with bowel loop herniated through the defect in the abdominal wall, and may have major or even lethal complications [2]. We report a case of handlebar hernia a male child of 3 years, who came for treatment 2 days afer the injury. Ultrasonography confrmed the clinical diagnosis of traumatic hernia. Te case was taken up for open surgery and anatomical repair was done with prolene. Te patient had an uneventful postoperative course. Case report A 3 -year old male was brought to our department with a reducible swelling measuring 6×4 cm in the lef side of lower abdomen afer sustaining a trauma by a bicycle handlebar, as it fell on his abdomen while he was lying fat. Tere were contusions in the lef lumber region with bulging swelling in the lef iliac fossa, increased with crying, (Figure 1). Abdomen was sof, but there was tenderness in the lef lumber and lef iliac fossa regions. An impulse on coughing was present in the lef lower quadrant and a defect could be felt in the anterior abdominal wall lateral to the rectus muscle and below the umbilicus. He was diagnosed as acute handlebar hernia. Routine investigations were within normal limits. Ultrasonography revealed only a defect of 8 x 4 cm in the abdominal wall muscles in the lef lower quadrant with bowel herniating through the defect. We planned for an open surgery. An oblique incision was made over the defect. On splitting the external oblique aponeurosis, the rent was visible. Te peritoneum was so adherent to the undersurface of external oblique aponeurosis that it got opened with external oblique aponeurosis. No viscus was adherent to the overlying external aponeurosis. Both the external and entire internal oblique aponeurosis was seen passing anterior to the semilunar edge of rectus abdominis very clearly. A plane was created between the internal oblique and the external oblique by sharp dissection with ease. No attempt was made to separate the transverses abdominis from the internal oblique and mobilise the peritoneum. Te gap was repaired with prolene 3-0 without any tension. Interrupted skin stitches were given with 2-0 silk (Figure 2). Te patient had uneventful recovery and has been under regular follow-up for the last 8 months. Discussion Acute abdominal wall hernias caused by traumatic force are exceedingly rare [1]. Tere are fewer than 50 cases reported in the Correspondence to: Awad Ali Mohamed Ahmed Alawad, Department of Surgery, Faculty of Medicine, University of Medical Sciences and Technology, Sudan, Tel: 00249912802545; E-mail: awadali82@hotmail.com Key words: handlebar, hernia Received: September 03, 2015; Accepted: October 01, 2015; Published: October 05, 2015 Figure 1. Three years child with acute handlebar abdominal hernia.