A 14 year old male was presented to the casualty on a saturday night with left sided upper abdominal pain. Clinical examination revealed massive splenomegaly. He has history of massive hematemesis 2 year back, and was diagnosed to have Extrahepatic Poal Venous Obstruction (EHPVO) and bleeding was controlled by ligation of the esophageal varices. What is the likely diagnosis?

**Core Concept**
Extrahepatic Portal Venous Obstruction (EHPVO) is a congenital anomaly of the portal venous system, characterized by obstruction of the portal vein or its branches outside the liver. This condition can lead to portal hypertension, resulting in complications such as esophageal varices and splenomegaly.

**Why the Correct Answer is Right**
The massive splenomegaly in this patient is likely due to portal hypertension, which causes blood to be diverted through collateral veins, leading to enlargement of the spleen. The history of massive hematemesis and esophageal varices is consistent with portal hypertension, which is a common complication of EHPVO. The clinical presentation of left-sided upper abdominal pain and massive splenomegaly in a patient with a history of EHPVO and bleeding esophageal varices suggests that the patient is experiencing a splenic rupture, which is a known complication of portal hypertension.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not take into account the patient's history of EHPVO and portal hypertension, which are key factors in this clinical scenario.
**Option B:** This option is incorrect because it does not provide a plausible explanation for the patient's symptoms and signs.
**Option C:** This option is incorrect because it does not consider the patient's history of bleeding esophageal varices and the potential for portal hypertension to lead to splenic rupture.

**Clinical Pearl / High-Yield Fact**
In patients with EHPVO, portal hypertension can lead to a range of complications, including esophageal varices, splenomegaly, and splenic rupture. It is essential to consider these complications in the differential diagnosis of patients with a history of EHPVO and portal hypertension.

**Correct Answer: C. Splenic rupture**

✓ Correct Answer: C. Splenic infarction