Which of the following is not seen in splenic trauma

Splenic injuries Most common injured blunt trauma abdomen : Spleen Pathophysiology Direct compression of the organ in the left upper quadrant of the abdomen Deceleration mechanism that tears the splenic capsule or parenchyma, mainly at areas fixed or tethered to the retro peritoneum Management With appropriate patient selection,many patients with blunt splenic trauma can be managed without splenectomy No bleeding patient should go without splenectomy or splenic repair, especially in an attempt to push the figurative non operative envelope Hemodynamic stability is a prerequisite for non operative management and must be present without ongoing intravascular volume suppo Hemodynamic stability is indicated by a normal blood pressure and lack of tachycardia, no physical examination findings indicating shock, and absence of metabolic acidosis. Non operative mangement is reserved for grades I, II and isolated grade III injuries Indications of operative management of splenic trauma Instability at admission Exact location of bleeding is unknown Failed nonoperative mamagement Best approach: Midline incision with packing of all four quadrants in cases of hemodynamic instability Drains should not be placed unless there is concern that the tail of the pancreas was also injured Splenic injury secondary to penetrating trauma Splenic injury secondary to penetrating abdominal trauma is usually identified during laparotomy and should be addressed based on the presence or absence of ongoing bleeding Splenectomy is performed in cases of ongoing bleeding Ref: Sabiston 20th edition Pgno : 435-437