MTOR and congenital secretory chloride diarrhea 1: Although initially splenic enlargement in patients with CLD was largely attributed to portal congestion, several studies have demonstrated that the pathophysiology is more complex, and splenomegaly has a congestive and a hyperplastic component.21 Increased activation of the mammalian target of rapamycin (mTOR) signalling pathway has also been observed as a cause of splenomegaly according to one of the studies.22