A Study of the Clinico-Etiological Profile of Splenomegaly Among Children in a Tertiary Care Hospital

Background Splenomegaly, or enlargement of the spleen, is a clinical sign rather than a standalone diagnosis, often indicating underlying systemic disease. In children, it may present due to a broad spectrum of conditions ranging from infections to hematologic, metabolic, or neoplastic disorders. The present study aimed to identify the etiological spectrum of splenomegaly among children admitted to the pediatric ward of a tertiary care hospital. The present study also sought to analyze the clinical profile, associated systemic findings, grading patterns, and assess treatment response and outcomes, thereby identifying region-specific trends that may guide early diagnosis and management strategies. Despite earlier studies addressing pediatric splenomegaly in different Indian populations, data from this coastal Andhra Pradesh region remain limited. Variations in endemic infection patterns, hematologic disorders, and socioeconomic determinants necessitate region-specific analysis to strengthen clinical decision-making and improve early detection strategies. Methods This prospective observational study included 115 children aged 0-15 years with clinically palpable splenomegaly who were admitted to the pediatric ward over a 12-month period. A detailed history and thorough physical examination were performed for all participants, and relevant investigations were conducted to determine the underlying etiology. The degree of splenic enlargement was assessed and graded using Hackett's classification as well as conventional clinical criteria. The etiology of splenomegaly was identified, and clinical outcomes, including response to medical treatment, need for surgical intervention, recurrence, and mortality, were documented systematically. Results In this study of 115 children with splenomegaly, a male preponderance was observed with 73 (63.4%) males and 42 (36.6%) females. The highest incidence occurred in children under six years of age. According to Hackett's classification, Grade III splenomegaly was the most common, seen in 51 (44.3%) patients. The most frequent presenting symptom was fever, reported in 80 (70%) children, while the most common clinical sign was pallor, observed in 58 (50.4%) patients. Infections were the leading cause of splenomegaly, accounting for 64 (55.7%) cases, followed by hematological disorders in 44 (38%) children, with storage and miscellaneous causes being less common. Regarding outcomes, the majority of children, 98 (85.2%), responded well to medical management. Splenectomy was required in five (4.3%) cases, mainly for refractory hematological disorders. Recurrence occurred in 10 (8.7%) patients, and mortality was low at two (1.7%), highlighting an overall favorable prognosis with timely diagnosis and appropriate therapy. Conclusion In the present study, splenomegaly in children was most commonly caused by infectious diseases, with malaria, enteric fever, and tuberculosis being the leading contributors. A male predominance was observed, and the majority of cases presented with moderate splenomegaly (Grade III). These findings underscore the importance of early recognition, prompt diagnosis, and timely management of underlying infections to prevent complications and improve outcomes in pediatric patients presenting with splenomegaly.