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Clinical Review Lesson of the week

Delayed presentation of handlebar injuries in children

BMJ 2001; 322 doi: (Published 26 May 2001) Cite this as: BMJ 2001;322:1288
  1. Jimmy P H Lam, senior house officer,
  2. Graeme J Eunson, senior house officer,
  3. Fraser D Munro, consultant paediatric surgeon (,
  4. John D Orr, consultant paediatric surgeon
  1. Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh EH9 1LF
  1. Correspondence to: F D Munro
  • Accepted 8 June 2000

Initial assessment of children with abdominal trauma from bicycle handlebars may provide false reassurances

Accidents represent the largest single cause of death in childhood. Although head injuries are the major cause of mortality and morbidity after bicycle accidents in children, abdominal injuries are not uncommon. Bicycle accidents account for 5-14% of blunt abdominal trauma in children.13 In general, injuries to the spleen, liver, or kidneys are readily evident soon after the accident; however, injuries to the bowel and pancreas often present late and result in greater morbidity.

Case reports

Case 1

An 11 year old boy fell off his bicycle and sustained a handlebar injury to his upper abdomen. He attended his general practitioner on the same day because of abdominal pain and vomiting, which was treated with an antiemetic drug. For the next 18 days the boy had vomiting, anorexia, weight loss, and increased epigastric pain. He was then referred to the local surgical unit for assessment.

Examination showed that he was anxious and pale, with a tender epigastrium and a palpable mass in his upper abdomen. His white blood count was 12.9×109/l and his serum amylase concentration was 2850 U/l. A diagnosis of traumatic pancreatitis was made and the boy was transferred to the regional paediatric surgical centre.

An ultrasound scan showed a large pancreatic pseudocyst (4.9 cm in diameter) lying between the body of the pancreas and the stomach. The boy was initially treated conservatively with total parenteral nutrition. However, over the next seven days …

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