Bucket-handle mesenteric tear and traumatic abdominal wall hernia following bicycle handlebar injury in an adult

INTRODUCTION AND IMPORTANCE: Bucket-handle mesenteric tear (BHMT) is a type of intestinal mesenteric injury where the intestine separates from its mesentery resulting in ischemia and perforation. Traumatic abdominal wall hernia (TAWH) is a disruption of the abdominal wall muscles and fascia in the presence of intact skin. BHMT and TAWH following bicycle handlebar injury in adults are rare. TAWH and generalized abdominal tenderness led to emergent surgical treatment in our patient. I aim to report these rare clinical entities in an adult patient with the management. This case report can create awareness among primary care physicians to decide on early referral and surgeons on early treatment. CASE PRESENTATION: A 55y man presented 4 h after a bicycle handlebar injury to the abdomen. He had generalized abdominal pain but no history of vomiting, smoking, diabetes, or hypertension. Lab results were insignificant. TAWH and generalized tenderness led to the additional diagnosis of hollow-viscus perforation, but laparotomy revealed BHMT of the ileum and transverse colon. We did TAWH repair, bowel resection, and end-to-end anastomosis with excellent results. CLINICAL DISCUSSION: BHMT following bicycle handlebar injury is rare in adults, with few case reports. Imaging is less sensitive, and surgery is the definitive diagnosis of BHMT.TAWH in adults after bicycle handlebar injury is rare and can be a sign of serious-intraabdominal injuries, and surgical repair is the treatment. CONCLUSION: BHMT and TAWH following bicycle handlebar injury are rare in adults. BHMT can be life-threatening if not detected and treated early.