Acute hemoperitoneum from rupture of a hepatocellular carcinoma

A male patient with cirrhosis presented with acute right upper quadrant pain, systemic hypotension, and falling hematocrit. Abdominal paracentesis confirmed acute hemoperitoneum, and abdominal computed tomography (CT) scan demonstrated a large hepatic mass consistent with hepatocellular carcinoma (HCC). This rare presentation of a malignancy uncommon in North America leads to a discussion of the differential diagnosis of acute hemoperitoneum and a review of the literature on acute hemoperitoneum and HCC.