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Abdominal Handlebar Injury

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

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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C. Intramural small-bowel hematoma

The computed tomography scan showed an intramural small-bowel hematoma with a complete bowel obstruction and no signs of perforation. Because of his persistent vomiting, the patient initially received a nasogastric tube. All oral intake immediately resulted in nausea that was relieved by nasogastric tube drainage. Because of the persistent vomiting, the patient underwent a laparotomy 2 days posttrauma, at which the diagnosis of a traumatic intramural jejunal hematoma with complete luminal obstruction was confirmed. The injured jejunal segment was resected, followed by an end-to-end anastomosis (Figure 2). The postoperative course was uncomplicated and his oral intake could be reinstated 2 days postsurgery.

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Article Information

Corresponding Author: Jurriën Stiekema, MD, PhD, Pediatric Surgical Center of Amsterdam, Emma Children's Hospital Academic Medical Center & Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands (j.stiekema@vumc.nl).

Published Online: December 6, 2017. doi:10.1001/jamasurg.2017.4930

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient’s mother for granting permission to publish this information.

References
1.
Scaglione  M, de Lutio di Castelguidone  E, Scialpi  M,  et al.  Blunt trauma to the gastrointestinal tract and mesentery: is there a role for helical CT in the decision-making process?  Eur J Radiol. 2004;50(1):67-73.PubMedGoogle ScholarCrossref
2.
Galifer  RB, Forgues  D, Mourregot  A,  et al.  Blunt traumatic injuries of the gastrointestinal and biliary tract in childhood. analysis of 16 cases.  Eur J Pediatr Surg. 2001;11(4):230-234.PubMedGoogle ScholarCrossref
3.
Peterson  ML, Abbas  PI, Fallon  SC, Naik-Mathuria  BJ, Rodriguez  JR.  Management of traumatic duodenal hematomas in children.  J Surg Res. 2015;199(1):126-129.PubMedGoogle ScholarCrossref
4.
Chen  H, Bai  YZ, Wang  WL.  Jejunal subserosal hematoma in an 11-year-old boy.  J Gastrointest Surg. 2011;15(12):2291-2292.PubMedGoogle ScholarCrossref
5.
Moon  SB, Jung  SE, Cheon  JE, Kim  WS, Park  KW.  Very large traumatic duodenal hematoma: successful percutaneous drainage in a child.  Eur J Pediatr Surg. 2009;19(6):412-413.PubMedGoogle ScholarCrossref
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