A 66-year-old man, of Vietnamese origin and currently residing in the USA, came to the emergency department of our centre after presenting with sudden, sharp pain in the epigastrium associated with a large meal. The pain radiated to the left shoulder. Examination revealed sweating and mucocutaneous pallor with preserved distal pulses.
The patient was hypotensive and tachycardic, his ECG was normal and, given the urgency of the symptoms, an abdominal ultrasound scan was requested, which revealed a mass in liver segment VI suggestive of hepatocarcinoma and the existence of free intracavitary fluid; an abdominal CT scan was then performed with contrast, which revealed very abundant haemoperitoneum and a lesion in liver segment VI compatible with hepatocarcinoma, probably ruptured and with a hyperdense focus next to the lesion, suggesting active bleeding. The blood test showed haemoglobin figures of 8.8 g/l, haematocrit of 0.249 L/L and 14,310 leukocytes with neutrophilia.
Given the instability of the patient and the findings of the imaging tests, we decided to perform urgent surgery.
At laparotomy, the lesion described in the ultrasound and CT scan was identified and it was decided to perform a segmentectomy, lavage and drainage of the cavity.
After 7 days (4 of them in the Intensive Care Unit) the patient was discharged from hospital.