Boy with hematemesis, melena and mild splenomegaly – Paediatrics MCQ

A 12 year old Boy with hematemesis, melena and mild splenomegaly presented to the paediatrics OPD. Examination revealed absence of jaundice / ascites. Most probable diagnosis is?

A. Extrahepatic Portal Venous Obstruction (EHPVO)
B. Cirrhosis
C. Non Cirrhotic Portal Fibrosis (NCPF)
D. Malaria with disseminated intravascular coagulation

Correct answer : A. Extrahepatic Portal Venous Obstruction (EHPVO)

• Hematemesis, melena and splenomegaly are suggestive of a diagnosis of portal hypertension
• The first three options can cause portal hypertension
• But considering the age and sex of the child, Extrahepatic Portal Venous Obstruction (EHPVO) is the most probable diagnosis
• Non Cirrhotic Portal Fibrosis (NCPF) is usually seen in adult females in the third or fourth decade
• Cirrhosis is not very common in children, and it is usually accompanied by jaundice / ascites