A handlebar injury to the abdomen
A 14 year old boy presented at the emergency department with severe abdominal pain in the right upper quadrant. Two hours before he had lost control of his bicycle and landed heavily on the handlebar. He had vomited once since.
On examination there was bruising to the right upper quadrant. The abdomen was soft but diffusely tender throughout the right side. There were no signs of haemodynamic instability. His white cell count was raised at 19×109/l (normal range 4-11×109/l), but all other results of blood tests were normal. Figure 1 shows the patient's initial plain abdominal radiograph and figure 2 the computerised tomogram that followed.
Blunt force causes injury to intra-abdominal organs by three different mechanisms.5 Shear forces, created by rapid deceleration, can cause organs and vascular pedicles to tear. Alternatively, organs may be crushed between the anterior abdominal wall and the vertebral column or posterior thoracic cage. Solid viscera,