[Skip to Navigation]
Sign In
JAMA Surgery Clinical Challenge
May 2018

Abdominal Trauma Related to a Bicycle Accident

Author Affiliations
  • 1Digestive Surgery and Surgical Oncology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, 125, rue de Stalingrad, Bobigny, France
  • 2Université Paris XIII, Bobigny, France
JAMA Surg. 2018;153(5):491-492. doi:10.1001/jamasurg.2018.0055

A 48-year-old man was admitted to our emergency department 12 hours after a bicycle accident with abdominal pain, nausea, and vomiting. He described abdominal trauma caused by the bicycle handlebar. The patient reported undergoing an appendectomy at age 23 years and having ulcerative colitis since he was aged 30 years. He had received treatment (mesalazine and corticosteroids) for inflammatory bowel disease that had been discontinued.

Physical examination revealed paraumbilical ecchymosis (Figure 1A), general abdominal tenderness, and distension. Body temperature, blood pressure, and heart and respiratory rates were normal. Laboratory test findings did not show abnormalities except for the leukocyte count (12 300 cells/μL [to convert to ×109/L, multiply by 0.001]); hemoglobin and hematocrit levels were within the reference ranges. An abdominal computed tomographic (CT) scan, performed immediately, revealed a pneumoperitoneum and free fluid in the lower quadrants of the abdomen (Figure 1B).

Add or change institution
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words