An 8-year-old Cameroonian boy with no significant past history was brought to our emergency service following a road traffic accident. On crossing a road, he was knocked down by an oncoming motorbike weighing approximately 125 kg, medium sized, and traveling at moderate speed. The motorbike fell on the boy with the handlebar catching him in the abdomen as its rider lost control. He sustained a lesion to the head with no initial loss of consciousness. On arrival, he complained of pain in his head and a swelling in the left upper quadrant of his abdomen.\nOn examination, he was conscious, with a Glasgow coma score of 15/15, blood pressure of 119/83 mmHg, pulse of 90 beats per minute, respiratory rate of 18 breaths per minute, temperature of 37.3 °C; he was 96 cm tall and weighed 26 kg. There was a 2 cm laceration in the occipital region of his head, and a swelling in his left lumbar region with mild bruising of the overlying skin (Fig. ). The swelling was reducible and disappeared in the supine position. There was no guarding and no rebound tenderness. He had normal bowel sounds on auscultation and the rest of the examination was unremarkable.\nA diagnosis of mild head injury and a handlebar hernia was made. After resuscitation, his scalp laceration was closed with a one point suture and he was programmed for surgery for the handlebar hernia the next day. A surgical exploration of the area showed a 7 cm laceration of his lateral abdominal wall (Fig. ), running from the external oblique aponeurosis through all the muscle layers to his peritoneum with loops of small bowel present in the opening. There was no blood or feces in the area immediately surrounding the lesion. Exploration of the bowel loops closest to the opening did not reveal signs of intra-abdominal injury. The abdominal wall defect was repaired in layers. The abdominal incision was closed in a standard manner. His postoperative period was uneventful. He was discharged on postoperative day 9 and scheduled 2 weeks later for a follow-up visit, but unfortunately was lost to follow-up.
A 70-year-old male was presented to the emergency department after being hit by a bull. He presented with a complaint of pain in the abdomen and swelling in the left lumbar region []. On presentation, his vital parameters (blood pressure: 120/80, pulse rate: 72/min, respiratory rate: 18/min, temperature: afebrile) were stable. On physical examination, his left abdomen was found to have a bulging mass, not reducible, without definite ecchymosis. There was mild tenderness and rebound tenderness over the protrusion, but there was no muscle guarding or generalized tenderness over the whole abdomen. We suspected the abdominal protrusion to be caused by a fascial disruption, although the demarcation could not be clearly delineated by physical examination. The bowel sounds were normal. The findings from the initial laboratory studies were normal. Chest and abdomen X-rays were normal. Abdominal ultrasound showed a small amount of free fluid in perihepatic space, pelvis, and in between gut loops and protrusion of omentum from lateral abdominal wall.\nAfter preoperative work-up, decision was made to operate. An incision was made over the herniation site, and omentum was found to be herniated out of the defect that was reduced into the peritoneal cavity []. After looking out for any bleeding from the omental vessels, blood collected in the peritoneal cavity was aspirated, and clots were removed, still looking out for the cause of hemoperitoneum. The surgery was converted into a midline laparotomy, and a thorough evaluation of solid organs and gut was carried out. Spleen, liver and small bowel were found to be normal.\nIntraoperatively, there was gangrene of a part of the transverse colon in its distal 1/3rd part near splenic flexure with a tear in the mesocolon []. The gangrenous portion of the transverse colon was resected and converted into colostomy. The tear in the mesocolon was repaired. Both abdominal wounds were closed in layers. Patient felt well after the surgery and was discharged on the 7th postoperative day. Closure of colostomy and primary repair of the hernia were done 3 months after the initial injury.