BMJ 2001;323:754 ( 29 September )

Letters

Duodenal haematoma occurs in children with bicycle injuries

The first 150 words of the full text of this article appear below.

EDITOR---Closed duodenal injury is a good topic to highlight as a lesson of the week. Surgical injuries to the upper abdomen are a fairly rare childhood injury, and few doctors will diagnose them with the necessary speed.1 Lam et al remind us to examine the paediatric abdomen carefully and frequently after blunt trauma and not to rely too heavily on imaging.

One other type of intra-abdominal damage caused by handlebar injury is not highlighted in this paper. The first and third parts of the duodenum may be crushed between the handlebar and the lumbar spine, causing rupture of the subserosal blood vessels and resulting in a slowly expanding intramural haematoma.2 The child may be relatively free of symptoms until the haematoma causes complete obstruction of the duodenal lumen; as a result, the diagnosis is often delayed.

Important clues to the diagnosis include the history of upper abdominal trauma, . . . [Full text of this article]
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Relevant Article

Lesson of the week: Delayed presentation of handlebar injuries in children
Jimmy P H Lam, Graeme J Eunson, Fraser D Munro, and John D Orr
BMJ 2001 322: 1288-1289. [Extract] [Full Text] [PDF]

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