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JAMA Surgery Clinical Challenge
February 2018

Abdominal Handlebar Injury

Author Affiliations
  • 1Pediatric Surgical Center of Amsterdam, Emma Children's Hospital Academic Medical Center & Vrije Universiteit Medical Center, Amsterdam, the Netherlands
JAMA Surg. 2018;153(2):179-180. doi:10.1001/jamasurg.2017.4930

A healthy 6-year-old boy presented to the emergency department after experiencing a bicycle handlebar injury. He complained about abdominal pain and had vomited twice. At physical examination, according to the Advanced Pediatric Life Support protocol, he had normal vitals results with pain during palpation of the left abdominal region without guarding. His hemoglobin level was 12.3 g/dL (to convert to grams per liter, multiply by 10) (normal value, 10.5-16.1 g/dL), amylase 68 U/L (to convert to microkatals per liter, multiply by 0.0167) (normal value, <85 U/L), and lipase 25 U/L (normal value, <60 U/L). A plain chest radiography result showed no signs of traumatic injury. Abdominal ultrasonography results showed a bowel loop with a thickened wall in the left abdominal region with no free abdominal fluid. He was admitted to the pediatric ward for close observation. The next day, his vomiting persisted, especially after oral intake. Computed tomography with oral and intravenous contrast was performed (Figure 1).

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