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).
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Le Bian AZ, Wind P. Abdominal Trauma Related to a Bicycle Accident. JAMA Surg. 2018;153(5):491–492. doi:10.1001/jamasurg.2018.0055
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