Traumatic tension pneumocephalus: Two case reports.

INTRODUCTION: Traumatic pneumocephalus rarely evolves into tension pneumocephalus. It can be devastating if not recognized and treated promptly. CASE PRESENTATION: We presented two cases of post-traumatic tension pneumocephalus. A 30- year old male pedestrian hit by a car presented with right frontal bone fracture extending to right frontal sinuses. He developed pneumocephalus involving all ventricles and subdural space and extending down to foramen magnum with tight basal cistern. The patient was managed conservatively. During the hospital course, he developed cerebrospinal fluid leak from the facial fractures and meningitis. After complete recovery, the patient was discharged home in a good health condition. The second case was a 43- year old lady driver who involved in a motor vehicle crash and presented with comminuted fracture of the right frontal bone, right parietal extra-axial hemorrhage. She developed pnemocephalus involving the bilateral frontal lobes, mainly on the left side with extension to the left lateral ventricle. Pneumocephalus was also noted in the pre-pontine cistern. The patient had rhinorrhea during the hospital course. The patient underwent wound debridement, intracranial pressure monitoring, and repair of her globe and advancement flap for right facial injury. CONCLUSIONS: These are two rare cases with posttraumatic tension pneumocephalus treated conservatively with a favorable outcome. Early diagnosis of tension pneumocephalus is a crucial step to facilitate early recovery; however, the associated injuries need attention as they could influence the hospital course.

The "Triple-Q Algorithm:" A practical approach to the identification of liver topography.

The descriptive identification and interpretation of liver pathology continue to raise debate, especially for trainees and junior physicians. There is wide diversity in the description of liver segmentation with sometimes contradictory terminology between French and American literature. Attempts were made to create a unified nomenclature that simplifies the problem. We propose a simple approach to describe the location of liver pathology in different settings by referring to an algorithm based on three questions. Explanations to answer these questions and correctly describe the location of liver pathology are herein described. In conclusion, we think that the adoption of such an algorithm called arbitrary "the Triple-Q Algorithm" will facilitate the understanding of liver topography for the young physicians, as well as it will allow for the accurate description and localization of the pathological lesions in the liver. This could be achieved after testing and validating this algorism in prospective studies. This could have academic and clinical implications in the medical education and the patient care.

Clinical Presentation and Time-Based Mortality in Patients With Chest Injuries Associated With Road Traffic Accidents.

BACKGROUND: Blunt chest trauma (BCT) poses significant morbidity and mortality worldwide. OBJECTIVES: We investigated the clinical presentation and outcome of BCT related to road traffic accidents (RTA). PATIENTS AND METHODS: A retrospective observational analysis for patients who sustained BCT secondary to RTA in terms of motor vehicle crash (MVC) and pedestrian-motor vehicle accidents (PMVA) who were admitted to the trauma center at Hamad general hospital, Doha, Qatar, between 2008 and 2011. RESULTS: Of 5118 traumatic injury cases, 1004 (20%) were found to have BCT secondary to RTA (77% MVC and 23% PMVA). The majority were males (92%), and expatriates (72%). Among MVCs, 84% reported they did not use protective devices. There was a correlation between chest abbreviated injury score (AIS) and injury severity scoring (ISS) (r = 0.35, r(2) = 0.12, P < 0.001). Regardless of mechanism of injury (MOI), multivariate analysis showed that the head injury associated with chest AIS and ISS was a predictor of mortality in BCT. Overall mortality was 15%, and the highest rate was observed within the first 24 hours post-trauma. CONCLUSIONS: Blunt chest trauma from RTA represents one-fifth of the total trauma admissions in Qatar, with a high overall mortality. Pedestrians are likely to have more severe injuries and higher fatality rates than MVC victims. Specific injury prevention programs focusing on road safety should be implemented to minimize the incidence of such preventable injuries.

Delayed bile leak in a patient with grade IV blunt liver trauma: A case report and review of the literature.

INTRODUCTION: Delayed bile leak following blunt liver trauma is not common. PRESENTATION OF CASE: We presented a case report and literature review of delayed bile leak in a young male patient who presented with grade IV blunt liver injury following a motor vehicle collision; he was a restrained driver who hit a fixed object. Physical examination was unremarkable except for revelaed tachycardia, right upper quadrant abdominal tenderness, and open left knee fracture. A diagnosis of grade IV multiple liver lacerations with large hemo-peritoneum was made and urgent exploratory laparotomy was performed. The patient developed a biloma collection post- operatively. He underwent endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct stenting. His recovery was uneventful, and he was discharged home after 1 month. DISCUSSION: This is a rare case with no intra or extra hepatic biliary radicle injury seen on magnetic resonance cholangiopancreatography (MRCP) and no evidence of leak by ERCP. A review of the literature to highlight the incidence of delayed bile leak revealed only few reported cases. CONCLUSION: Our findings demonstrate the need for prompt diagnosis and treatment of delayed bile leak in blunt liver injuries. When these principles are followed, a successful outcome is possible.