Case presentation A 2-year-old boy presented with a two-day history of melena and hematemesis. His prenatal, birth, and neonatal history were unremarkable.
He was diagnosed with polycystic kidneys at the age of one and had no previous history of abdominal pain. Physical examination Acutely ill-looking boy with generalized paleness Protuberant and distended abdomen with a circumference of 56 cm Hepatomegaly of 7 cm below the costal margin Splenomegaly measuring 4 cm below the costal margin Laboratory investigations Hemoglobin: 9.9 g/dL Hematocrit: 26.8% WBC count: 9460/µL Serum creatinine: 1.1 mg/dL Blood urea nitrogen(BUN): 74 mg/dL Alanine aminotransferase (ALT): 32 IU/L Alkaline phosphatase: 196 IU/L Radiographic investigations Upper gastrointestinal endoscopy : Esophageal varices secondary to portal hypertension Abdominal ultrasound: Enlarged liver, measuring 11.6 cm with altered…
