Analysis of the use of upright abdominal radiography for evaluating intestinal perforations in handlebar traumas: Three case reports

RATIONALE: Intestinal perforations due to blunt abdominal handlebar trauma are difficult to diagnose. This report presents a retrospective analysis of 3 patients with intestinal perforations due to abdominal bicycle handlebar trauma who were diagnosed via upright abdominal radiography. PATIENTS CONCERNS: All the patients lost their balance while riding a bicycle for leisure and had fallen on the handlebar tip. The patients were initially misdiagnosed at different-level health centers despite various radiologic investigations performed. DIAGNOSIS: The patients’ intestinal perforations were diagnosed via plain upright abdominal X-ray radiography (UAXR) in our institution. INTERVENTIONS AND OUTCOMES: The children underwent exploratory laparotomy due to intestinal perforations. All the perforations were repaired either with primary closure or bowel resection and anastomosis with successful outcomes. LESSONS: Pneumoperitoneum due to intestinal perforation can be diagnosed via UAXR with appropriate patient positioning and timing. This case series shows that to accurately diagnose intestinal perforations, upright plain X-ray should be routinely performed, carefully evaluated, and repeated in patients with enduring abdominal complaints.