A 5 year boy presented with massive haemetemesis. He is not febrile. Per abdomen examination revealed massive splenomegaly without hepatomegaly. Most probable diagnosis would be: March 2005
**Core Concept**
The clinical presentation of a 5-year-old boy with massive hematemesis (vomiting blood) and massive splenomegaly (enlarged spleen) without fever or hepatomegaly (enlarged liver) suggests a diagnosis related to portal hypertension. The spleen's enlargement is likely due to increased blood flow through the portal vein.
**Why the Correct Answer is Right**
In this scenario, the most probable diagnosis is an **obstruction of the portal vein**, which leads to increased pressure in the portal venous system. This obstruction can cause the spleen to enlarge due to the increased blood flow through the splenic vein. The absence of hepatomegaly suggests that the liver is not significantly involved in the obstruction. A common cause of portal vein obstruction in children is a **thrombosis** of the portal vein, which can be idiopathic or secondary to a congenital anomaly, trauma, or infection.
**Why Each Wrong Option is Incorrect**
**Option A:** While liver diseases can cause portal hypertension, the absence of hepatomegaly in this case makes it less likely. Liver diseases typically cause both splenomegaly and hepatomegaly due to the involvement of the liver in the disease process.
**Option B:** Gastroesophageal varices can cause hematemesis, but they are often associated with liver cirrhosis, which is not suggested by the absence of hepatomegaly.
**Option C:** Splenic vein thrombosis can cause splenomegaly, but it is less likely to cause massive hematemesis compared to portal vein thrombosis.
**Option D:** While infections can cause splenomegaly, the absence of fever and the massive nature of the splenomegaly make an infectious cause less likely.
**Clinical Pearl / High-Yield Fact**
A key point to remember is that **massive splenomegaly without hepatomegaly suggests a diagnosis related to portal hypertension**, which can be caused by an obstruction of the portal vein.
**Correct Answer:** C.