title: Bleeding from ruptured hepatic metastases as a cause of syncope in an octogenarian: a case report.
abstract: BACKGROUND
  Acute hemoperitoneum as a result of hemorrhage from liver metastases is an uncommon but serious condition. The use of appropriate imaging is important in the diagnosis and can have a profound impact on subsequent management. This case is important because the presentation was of recurrent syncopal episodes with an unusual underlying cause. This case highlights the need to consider this diagnosis in the differential in patients presenting with collapse in the acute setting.
  
  
  METHODS
  We present the case of an 85-year-old Caucasian man who was admitted following a collapse episode and was found to be persistently hypotensive despite aggressive resuscitation. An acute intra-peritoneal bleed originating from hepatic metastases from an unknown primary was identified promptly with computed tomography imaging and was subsequently managed conservatively.
  
  
  CONCLUSIONS
  This case aims to convey key teaching points: (A) the need to consider intra-abdominal hemorrhage in the differential diagnosis when assessing patients with collapse; and (B) the use of appropriate imaging such as computed tomography can facilitate a prompt diagnosis and appropriate management steps can then be taken accordingly.
authors.affiliation: Department of Stroke Medicine and Medicine for the Elderly, King's Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Nottingham NG17 4JL, UK. Mazen.rizeq@sfh-tr.nhs.uk.
authors.forename: Ian W
authors.initials: IW
authors.lastname: Seetho
authors.forename: Simon
authors.initials: S
authors.lastname: Stinchcombe
authors.forename: Mazen M
authors.initials: MM
authors.lastname: Rizeq