Il segno del manubrio nel trauma addominale pediatrico: due casi clinici e revisione del significato diagnostico

Abdominal injuries caused by bicycle handlebar impact, although potentially severe, are often underestimated. In children the handlebar acts as a blunt object with a small surface area, transmitting concentrated impact energy and causing visceral damage even at relatively low speeds. External signs are frequently minimal and symptoms may develop with delay, thus the risk of missed or late diagnosis increases. The presence of the so-called “handlebar sign”, even in haemodynamically stable patients and in the absence of other clinical findings, should therefore be considered suggestive of high-energy trauma and regarded as a warning sign for possible internal injury. The paper reports two clinical cases of blunt abdominal trauma in which contrast-enhanced computed tomography (CT) enabled the diagnosis of severe intra-abdominal injuries. These cases highlight that abdominal pain, elevation of hepatic or pancreatic enzymes and the presence of a visible handlebar mark after trauma are strong indicators of possible organ injury. Although abdominal ultrasound is useful as an initial diagnostic tool, it may provide falsely reassuring results, particularly when clinical or laboratory warning signs are present. In such circumstances, contrast-enhanced CT should be considered the choice of diagnostic modality, as it enables prompt and accurate identification of intra-abdominal injuries and supports timely clinical management.