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This article describes how the liver is one of the most commonly injured organs in the abdomen, especially in road traffic accidents. Patients do present with polytrauma and those who are hemodynamically unstable have a high morbidity and mortality, even in advanced hospital settings. Following is the case report of a 17-yr. old boy, who was involved in a road traffic accident with polytrauma, presented to a tertiary care hospital in a remote island, with Grade IV-V liver injury and developed ARDS in post-operative period. The patient was managed successfully and discharged.