Introduction: Splenomegaly is an important sign of an underlying disorder and its etiology ranges from infectious disease to malignancy. Primary diseases of spleen are uncommon. Etiology of splenomegaly varies according to the geographical areas studied and depends upon the endemic, genetic and hematological diseases in the particular region. Purpose of this study was to find out the causes of splenomegaly in a tertiary care centre.

Methods and Materials: This cross sectional, observational study was carried out at Department of Medicine, IGIMS Patna (Bihar). 156 Male and Female patients older than 13 years of age and admitted in medicine ward with enlarged spleen were selected for this study. After getting informed consent from patients, Performa was filled; elaborating history, important clinical findings and relevant investigations were performed to find out the cause. Data analysis was carried out by SPSS 16 statistical software.

Results: Most common splenomegaly patients belong to Hackett’s grade II (49%), followed by grade III (32%), grade I (13%) & grade IV (6%). Most common etiological category of splenomegaly was infective (30%) followed by congestive (24.5%), hematological malignancy (24%), megaloblastic anemia (13.5%), hemolytic anemia (4%) and other (4.5%) causes. Among infective etiology malaria was most common cause (9%) followed by dengue fever (7%). Chronic liver disease (12.5%) and alcoholic liver disease (5%) were common cause in congestive group. Acute leukemia (13.5%) was most common cause of splenomegaly in hematological malignancy group.

Conclusion: Megaloblastic anemia and acute leukemia are the most common disease that leads to splenomegaly in population studied. Malaria in infectious group and chronic liver disease in congestive group appear to be the major contributors for splenomegaly. So finding of enlarged spleen needs clinical work up to reach the correct diagnosis.

Keywords: Splenomegaly, malaria, hematological malignancy, hemolytic anemia, abdominal discomfort.

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