• Murat Alkan, Serdar H Iskit, Sureyya Soyupak, Recep Tuncer, Hasan Okur, Erbug Keskin, and Unal Zorludemir.
• Department of Pediatric Surgery, Cukurova University Faculty of Medicine, Adana, Turkey. drmuratalkan@hotmail.com
• Pediatr Emerg Care. 2012 Apr 1; 28 (4): 357-60.

ObjectivesTo emphasize the severity of the underlying injury which may not be realized during the initial patient admission to the emergency department.MethodsA retrospective case note review of children admitted to our institution with the severe abdominal injury.ResultsEight children were identified with the severe abdominal injury secondary to the trauma from a bicycle handlebar that needed special care in the intensive care unit. All injuries were due to blunt trauma. The mean delay from the time of the accident to the time of presentation was 34.5 hours. All patients had an imprint of the handlebar edge on the hypochondrium. There were 3 pancreatic lacerations, 1 duodenal laceration, 1 jejunal laceration, 1 liver laceration, 1 abdominoinguinal laceration that all required open surgery, and 1 duodenal hematoma that resolved in 4 weeks follow-up period. The patients who required open surgery were evaluated with computed tomographic scans before surgery.ConclusionsChildren with an imprint made by the handlebar edge on the abdominal wall or give a clear history of injuries by a bicycle handlebar should be treated with great care. Early computed tomography evaluation may help to reduce the morbidity resulting from the delay in diagnosis of injuries to the internal organs.

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