Surgical decision-making in paediatric penetrating trauma: case report from two paediatric tertiary centres

Introduction: Penetrating trauma in children is relatively uncommon but is associated with significant morbidity and mortality, particularly when major vascular or visceral structures are involved. Owing to anatomical and physiological differences, as well as limited paediatric-specific evidence, surgical decision-making remains challenging and often relies on extrapolation from adult data. This study aimed to describe the surgical decision-making strategies for haemodynamically stable paediatric patients with penetrating injuries, highlighting the roles of clinical assessment, imaging, and multidisciplinary management. Methods: We report a retrospective case series of three paediatric patients with penetrating trauma who were managed at two tertiary paediatric referral centres. The clinical presentation, diagnostic workup, surgical approach, and outcomes were analysed. Case description: All patients were haemodynamically stable on admission but presented with penetrating injuries involving high-risk anatomical regions. Contrast-enhanced computed tomography played a key role in the preoperative assessment of extremity injuries, whereas surgical exploration was deemed mandatory in the presence of abdominal evisceration, despite stable vital signs. A tailored surgical approach based on clinical and radiological findings allowed safe foreign body removal or exploratory surgery without major complications. No vascular or visceral injuries requiring repair were observed. The postoperative course was uneventful, and no early or late complications occurred during follow-up. Conclusion: Penetrating trauma in haemodynamically stable paediatric patients requires individualised decision-making, supported by careful clinical evaluation, appropriate imaging, and multidisciplinary collaboration. Selective surgical exploration guided by injury pattern and anatomical risk can result in favourable outcomes while avoiding unnecessary procedures.