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Camera, action, liver injury: a preventable case of extreme sports body camera causing severe blunt abdominal liver trauma

This case report relates to a 25 year old man, previously fit and well, who sustained a 3 m fall from a mountain bike jump. In addition to full protective gear and helmet, he wore an live action video camera strapped to his lower chest by a chest mount harness strap. This slipped down to his epigastrium during the jump. Travelling at 20 km per hour, he ascended a 2 m ramp and lost control mid-air, landing over the handlebars, prone, onto his torso. He had no loss of consciousness and mobilized post with severe ongoing upper abdominal pain. Bystanders recorded the event and contacted Ambulance Victoria. Examination found significant upper abdominal tenderness, guarding and clearly delineated square shaped bruising, matching the dimensions of his video recording device (Fig. 1). Abdominal free fluid was identified on eFAST. He was haemodynamically stable, so proceeded to a computed tomography scan. Imaging demonstrated an American Association for the Surgery of Trauma (AAST) grade 4 liver laceration, predominantly of the left lobe of liver, with moderate volume hemoperitoneum without contrast extravasation (Fig. 2). He was admitted to the High Dependency Unit for monitoring. Despite an initial haemoglobin drop of 120–111 over 24 h, he remained stable. He had liver function test derangement with transaminitis; ALT and AST of over 1000. Serial abdominal examination and blood tests were stable. He was successfully treated with nonoperative management without transfusion or angioembolisation and was discharged home 5 days post injury with outpatient hepatobiliary clinic follow up. Serious mountain bike riding injuries can occur, often in remote locations. This can be attributed to the high speeds and rough, steep trail terrain. Most acute severe injuries of competitive riders occur from falling forward (65%), with a higher incidence in young men. Injuries to the head, extremities and spine are most frequent. Abdominal injuries are uncommon and are often associated with focal blunt force transmission from handlebar contact. In an American study of over 1000 patients over a 10 year period, abdominal trauma accounted for only 5.4% of injuries requiring trauma centre admission. Of these, liver injury occurred in 15% of patients with abdominal injury. Blunt liver injury is most often caused by direct force transmitted to the right upper quadrant, from motor vehicle collisions, falls from height and pedestrians struck by car. Following motor vehicle collisions, patients with abdominal seat-belt sign (SBS) have been found to have increased risk of specific regional injuries underlying skin markings. In particular, liver injury is 3.1-fold higher with SBS compared with those without SBS. Similarly, our patient presented with a well delineated skin marking overlying the left lobe of their liver, correlating with underlying injury. Although seatbelts play a protective role in mitigating morbidity and reducing mortality in motor vehicle collisions, attached torso video cameras only offer retrospective entertainment. Although use of recording devices is common in extreme sports, there is an important injury prevention message to learn from this case. The AAST Grade IV liver injury sustained in this case was considered avoidable. Without wearing the camera, the impact from the collision with the ground would have been more evenly distributed, and much less likely to cause such a high-grade focal injury. To our knowledge, this is the first case report depicting blunt abdominal injury associated with torso placement of a video recording device. Our patient’s injury clearly demonstrates the risk that solid, attached objects confer, yet there is a paucity of current literature surrounding mounted body cameras. There is only one paper on helmet-mounted cameras, finding no increase in head injury. However, this paper examined the biomechanical response using a head foam and may not accurately represent real word injuries. No papers have assessed abdominal or wrist-mounted cameras. Whether mounting a camera to a helmet, chest harness or any other