Question:medium
A 12-year-old boy presents with hematemesis, melena and splenomegaly. What is the most probable diagnosis?
A 12-year-old boy presents with hematemesis, melena and splenomegaly. What is the most probable diagnosis?
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Most common cause of variceal bleeding in a child with preserved liver function.
Updated On: Jun 24, 2026
- Non-cirrhotic portal fibrosis (NCPF)
- Cirrhosis
- Malaria with DIC
- Extrahepatic portal venous obstruction (EHPVO)
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The Correct Option is D
Solution and Explanation
Frame the case as portal hypertension because the triad of hematemesis, melena and splenomegaly points to bleeding gastro-oesophageal varices fed by a high portal pressure. The decisive variable is the patient's age. In the paediatric population the commonest reason for variceal haemorrhage with an enlarged spleen but otherwise normal hepatic synthetic function is blockage of the portal vein outside the liver, that is extrahepatic portal venous obstruction, often from a portal cavernoma. Work through the rivals: non-cirrhotic portal fibrosis is a disease of young and middle-aged adults; cirrhosis would be unusual in a 12-year-old and would carry stigmata of liver failure; malaria complicated by disseminated intravascular coagulation produces fever and generalised bleeding, not a clean picture of variceal bleed with splenomegaly. The child's preserved liver and the pre-hepatic level of obstruction make EHPVO the best fit.
$ \text{child} + \text{variceal bleed} + \text{splenomegaly} + \text{normal liver} \Rightarrow \text{EHPVO} $
\[\boxed{\text{Extrahepatic portal venous obstruction (EHPVO)}}\]
$ \text{child} + \text{variceal bleed} + \text{splenomegaly} + \text{normal liver} \Rightarrow \text{EHPVO} $
\[\boxed{\text{Extrahepatic portal venous obstruction (EHPVO)}}\]
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