INTRODUCTION

Massive splenomegaly presenting with hypersplenism, pancytopenia and portal hypertension, without any underlying known cause is known as Banti's syndrome. There are various causes of splenomegaly. When all the known causes of portal hypertension are ruled out, it is termed as Banti's syndrome. This syndrome was discovered by Guido Banti in 1882 and is named after him. Banti's syndrome is also known as idiopathic portal hypertension or non-cirrhotic portal fibrosis. [1] Banti's syndrome is commonly found in India and Japan than in the West. [2]

There is absence of any haematologic cause, primary hepatic cause or any tumour or mass lesion involving the spleen. Banti had stated that the primary organ involved was spleen and not the liver leading to secondary splenomegaly. Other features include normal liver function tests, varices seen in endoscopy, cytopenia of one or more cell lines, absence of cirrhosis, patent hepatic veins and elevated portal pressure with multiple collaterals. The complications include rupture of varices and massive bleeding. [3] We report a case of a 20-year-old male who presented to us with a history of fever for 7 days and one-episode of hematemesis on the day of admission. All known causes of hypersplenism were ruled out and he was diagnosed to have idiopathic massive splenomegaly with portal hypertension and hypersplenism.

PRESENTATION OF CASE

A 20-years-old male, non-alcoholic came with complaint of one episode of hematemesis about 150 ml 1 hour back. There was no history of jaundice, diarrhoea, easy bruising, melaena, distension of abdomen, swelling over feet, cough, altered sensorium, chest pain, palpitations, breathlessness, orthopnea or paroxysmal nocturnal dyspnoea (PND). Patient was not a known case of any chronic illness. He did not have similar complaints in the past.

On general examination patient was well built and well oriented. He was afebrile. His pulse was 92 / min, regular, normal volume and character. Blood pressure was 110 / 70 mmHg. There was no sign of pallor, icterus, clubbing, cyanosis, lymphadenopathy and oedema. Jugular venous pressure (JVP)...