Hernia (2007) 11:365–367 DOI 10.1007/s10029-007-0190-y 123 CASE REPORT Traumatic handlebar hernia associated with hepatic herniation: a case report and review of the literature Nikhil Talwar · Madhu Natrajan · Surender Kumar · Puneet Dargan Received: 14 December 2006 / Accepted: 2 January 2007 / Published online: 30 January 2007  Springer-Verlag 2007 Abstract A traumatic abdominal wall hernia (TAWH) is a rare type of hernia that occurs after blunt trauma to the abdomen. TAWH caused by direct trauma from bicycle handlebars is even more rare with fewer than 30 cases having being reported. Recognition of these hernias is important, because they may be associated with signiWcant intrabdominal injuries. Despite an overall increase in incidence of blunt abdominal trauma, cases of TAWH remain rare, probably because of elasticity of the abdominal wall resists the shear forces generated by a traumatic impact. A high level of clinical suspicion is required for diagnosis of TAWH in patients with handlebar injuries. We present the case of a 20-year-old man with a traumatic handlebar hernia associated with herniation of the liver and hepatic duc- tal injury, which was managed successfully by a delayed repair of the hernia. Keywords Traumatic abdominal wall hernia · Abdominal injury · Liver Abbreviations TAWH Traumatic abdominal wall hernia CT Computed tomography MRI Magnetic-resonance imaging MRCP Magnetic-resonance cholangiopancreatography Introduction A TAWH is an unusual occurrence after blunt abdom- inal trauma. There is disruption of the abdominal wall musculature and fascia, but the overlying skin remains intact [1]. Handlebar hernia, a term coined by Dimyan et al. in 1980 [2], is traumatic abdominal wall hernia caused by blunt impalement on handlebars. Despite the increasing incidence of abdominal trauma, this type of hernia is rare because the elasticity of the abdominal wall resists the shear forces generated by a traumatic impact [3]. Fewer than 30 cases of traumatic handlebar hernias have been reported in the literature [4]. We present a case of a handlebar hernia associated with herniation of the liver through an abdominal wall defect, with injury to intrahepatic bile ducts. The patient was managed conservatively in the initial period followed by delayed repair of the hernia. The unusual clinical, radiological, and operative Wndings of the case are discussed and the literature is reviewed. Case report A 20-year-old man presented to the emergency depart- ment of our hospital 6 h after sustaining a handle bar injury to the upper abdomen in a motor vehicle accident. N. Talwar · S. Kumar · P. Dargan Department of Surgery, Lady Hardinge Medical College, University of Delhi, New Delhi 110001, India M. Natrajan Department of Radiodiagnosis, Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India P. Dargan (&) 2/532 Ekta Garden, I P Extension, New Delhi 110092, India e-mail: puneetdargan@gmail.com