Emergency Management of Ureteric Transection Injury Secondary to Bicycle Handlebar Injury

We present a unique case of ureteric transection and jejunal injury secondary to bicycle handlebar injury. Ureteric trauma is rare, occurring in <1% of all traumas. Bicycle handlebar injury is a unique trauma mechanism especially noticed in childhood. Damage to the ureter usually results from a significant traumatic event that is almost always associated with concomitant injury to other abdominal structures. Much of the presentation and management of ureteral injuries are dictated by the severity and management of the associated injuries. The emergency management includes the bare minimum possible to tide over the crisis when the patient is haemodynamicaly stable.

An otherwise healthy 13-year-old male presented to the Emergency department after a bicycle accident. Upon initial examination there was herniation of bowel through the abdominal wound, so exploratory laparotomy was performed. More than 75% of the jejunum's circumference was transected at a distance of 10 cm from the duodeno-jejunal flexure, and the upper third of the left ureter was transected close to the left renal pelvis with a foreign body (child's cloth remnant) visible. These injuries were initially treated by temporarily bridging the two transected ends with an infant feeding tube due to a 3 cm defect. His per cutaneous nephrostomy insertion procedure followed. After three months, the patient underwent a left sided pyeloureterostomy over a DJ stent for a final repair.

This case demonstrates the emergency and delayed definitive management of ureteric transection and jejunal injury secondary to penetrating bicycle handlebar injury.