A 38-year-old north Indian man was brought to the emergency department of our hospital after suffering a head-on collision while driving his car. On examination, he was conscious, oriented, and, in severe pain. His vital signs were normal, except for tachycardia. There were no signs of head, chest, pelvic, or limb injury. A visible swelling was present in the umbilical and epigastric regions with overlying bruising of the skin (Figure ). On palpation, it was tender, firm, non-pulsatile, and non-reducible, but there was a slight increase in size over the next hour. The patient was triaged as a blunt trauma abdomen - a probable steering wheel injury, hemodynamically stable, with probable rectus hematoma. Expectant treatment was started and a computed tomography (CT) scan was performed. The CT scan (Figure ) revealed a supra-umbilical defect in the midline anterior abdominal wall (maximum diameter 5 cm), with herniation of bowel loops and mesentery through it, with extensive interstitial edema. There was also associated free fluid in the peritoneal cavity, and a minor splenic laceration. Anticipating strangulation of the bowel, the abdomen was explored through a midline incision. There were 2-3 loops of edematous jejunum and mesentery in the subcutaneous space, herniating from a full-thickness defect in the abdominal wall. There was also a mesenteric hematoma with loss of vitality of the corresponding jejunal segment (one foot). A resection-anastomosis was performed. No other solid organ injuries were seen. The defect was repaired with an interrupted monofilament polypropylene suture without tension. The patient's wound healed without complications and was discharged on the 6th day. He was asymptomatic, 1 month after the operation.
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.