WOFAPS 2025 8th World Congress of Pediatric Surgery

Dimitar Dachev, Keti Tokmakova, Penka Stefanova

Medical University of Plovdiv Bulgaria

Trauma is the leading cause of death in children, with abdominal injuries accounting for a significant proportion of these cases. Blunt trauma is the most common mechanism, often resulting in injury to the parenchymal organs of the abdomen—most notably the liver, spleen, and kidneys. Children are particularly vulnerable due to their anatomical characteristics: proportionally larger organs, thinner abdominal walls, and greater vascularity, which increase the risk of internal bleeding even after minor trauma. Abdominal trauma involving solid organs is a major contributor to morbidity and mortality in children.

This paper outlines the current approach to managing such injuries in the pediatric population, with particular attention to the assessment and treatment of hemorrhage. Non-operative management (NOM) is emphasized as the preferred strategy in stable patients, while surgical intervention remains essential in cases of hemodynamic instability.

For the last ten years in the Department of Pediatric surgery – Medical University – Plovdiv – Bulgaria 108 cases with abdomial trauma are hospitalized. The spleen was the most commonly injured organ (46%), followed by the liver (38%) and kidneys (16%). Non-operative management was successful in 88% of hemodynamically stable cases. Surgical intervention was required in 12% of cases due to persistent bleeding.

Prompt and accurate diagnosis is crucial, as the clinical presentation of internal bleeding in children can be subtle and non-specific

Parenchymal abdominal organ trauma in pediatric patients demands careful evaluation and timely decision-making. Non-operative management is highly effective in most stable cases and is now the standard of care. An individualized approach, taking into account the unique physiological characteristics of children, is essential for optimizing outcomes.