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Management of liver injury is challenging particularly for the advanced grades. Increased utility of nonoperative management strategies increases the risk of developing massive liver necrosis (MLN). We reported a case of a 19-year-old male who presented with a history of motor vehicle crash. Abdominal computerized tomography (CT) scan revealed large liver laceration (Grade 4) with blush and moderate free hemoperitoneum in 3 quadrants. Patient was managed nonoperatively by angioembolization. Two anomalies in hepatic arteries origin were reported and both vessels were selectively cannulated and bilateral gel foam embolization was achieved successfully. The patient developed MLN which was successfully treated conservatively. The follow-up CT showed progressive resolution of necrotic areas with fluid replacement and showed remarkable regeneration of liver tissues. We assume that patients with high-grade liver injuries could be managed successfully with a carefully designed protocol. Special attention should be given to the potential major associated complications. A tailored multidisciplinary approach to manage the subsequent complications would represent the best recommended strategy for favorable outcomes.

BACKGROUND: Workplace-related injuries carry a significant health care challenge. The state of Qatar is developing rapidly, with much construction and an expanding industrial work force. This study aimed to assess the incidence and social impact of work-related injuries requiring hospitalization caused by falling objects at the construction sites. METHODS: We performed a prospective study for all admissions, which resulted from falling objects between January 2008 and June 2010 at the only trauma center in the state of Qatar. Data were analyzed, and outcomes were described (mortality, length of hospital stay, and safety measures). RESULTS: Of the total injured patients (N = 4,302) admitted between January 2008 and June 2010, 185 (4%) had injuries caused purely by falling objects. Patients' mean age was 29 years, and 97% of the patients were men. All injuries occurred at construction sites. Most patients (86%) were brought by ambulance, and the reminder was brought by private vehicles. After initial evaluation and resuscitation, 120 patients (65%) were found to have a single-system injury, and 65 (35%) had multisystem injury. Operative interventions were required in 50% of the patients. Mean length of hospital stay varied from 6.5 days for single-system injuries to 19 days for multisystem injuries. Safety devices were used in 32 patients (17.3%). All of the 16 mortality cases (8.6%) were reported in multiple injuries. CONCLUSION: Traumatic injury caused by falling object represents a significant problem in a rapidly developing country. Many of these injuries could be prevented by following established safety guidelines. LEVEL OF EVIDENCE: Epidemiologic study, level III. Language: en

Background: Serum troponin T (TnT) is a common marker of myocardial injury. However, its implication in the absence of clinical evidence of cardiac reason is not well established. Aims: The aim of this study was to identify the implications of positive TnT in traumatic chest injury (TCI) patients regardless of the cardiac involvement. Materials and Methods: We conducted a retrospective analysis of all TCI patients admitted to level 1 trauma center between 2008 and 2011. Patients who underwent TnT testing were divided into two groups: Group 1 (positive TnT) and Group 2 (negative TnT). The two groups were analyzed and compared, and multivariate regression analyses were performed to identify predictors of TnT positivity and mortality. Results: Out of 993 blunt TCI patients, 19.3% had positive TnT (Group 1). On comparison to Group 2, patients in Group 1 were 5 years younger and more likely to have head, cardiac, hepatic, splenic, and pelvic injuries, in addition to lung contusion. Positive TnT was associated with higher Injury Severity Score (ISS) (P = 0.001), higher chest Abbreviated Injury Score (AIS) (P = 0.001), and longer hospital stay (P = 0.03). In addition, Group 1 patients were more likely to undergo chest tube insertion, exploratory laparotomy, mechanical ventilation, and tracheostomy. Twenty patients had cardiac involvement, and of them 14 had positive TnT. Among 973 patients who showed no evidence of cardiac involvement, 178 had positive TnT (18.3%). There were 104 deaths (60% in Group 1). On multivariate regression analysis, the predictors of hospital mortality were positive TnT, head injury, and high ISS, whereas, the predictors of TnT positivity were cardiac, hepatic, and pelvic injuries; higher ISS; and age. Conclusions: Positive TnT in blunt TCI patients is a common challenge, particularly in polytrauma cases. Patients with positive TnT tend to have the worst outcome even in the absence of clinical evidence of acute cardiac involvement. Positive TnT is also a reflection of the severity of chest or extrathoracic injuries; however, further prospective studies are warranted.