Answer is D (Oesophageal varices) Oesophageal variceal bleeding secondary to poal hypeension .should always be the initial diagnosis in a young patient presenting with massive hematemesis and a moderate to large splenomegaly' Features in our of oesophageal varices: Most common presentation of oesophageal varices is G.I. bleed, which may be 'massive'. - Massive hematemesis in children is almost always due to variceal bleed - Shwaz - Gastrointestinal bleed in peptic ulcer disease usually occurs in persons who are > 60 years old i.e. (it ceainly is an uncommon presentation in a young boy) - Harrison - Erosive drug induced gastritis is usually superficial therefore hemodynamically significant 'massive' bleeding is rare Patients presents with moderate splenomegaly which is an impoant pointer towards presence of poal hypeension. - Absence of any significant history of altered liver function in the presence of poal hypeension could well be attributed to an extrahepatic causes of poal hypeension.