title: Spontaneous rupture of hepatocellular carcinoma presented as low back pain to an emergency department: a case report.
abstract: BACKGROUND
  Spontaneous haemoperitoneum due to rupture of hepatocellular carcinoma (HCC) is a surgical emergency and may have catastrophic outcomes.
  
  
  METHODS
  A 62-year-old male presented with nausea, dizziness and low back pain. There was no history of malignancy. Physical examination revealed a surgical abdominal emergency, but there was no physical finding that pointed towards a specific diagnosis. Laboratory studies revealed decreased haematocrit (27.6%) and increased INR (2.8) levels. A computed tomography scan showed a tumoral lesion within the fourth segment of the liver and fluid collection (haemoperitoneum) with normal vascular and intra-abdominal structures.
  
  
  METHODS
  Exploratory laparotomy was performed; the appearance of the liver was cirrhotic and nodular. Actively bleeding tumoral lesion was confirmed in fourth segment of the liver, "packing" applied with sponges to stop bleeding. On the post-operative day 22, the patient was discharged.
  
  
  CONCLUSIONS
  Spontaneous rupture of HCC is rare and should be considered in the differential diagnosis of non-traumatic spontaneous haemoperitoneum.
authors.affiliation: Marmara University, Emergency Medicine, Tophanelioglu c, Istanbul, 34150, Turkey.
authors.forename: Ozge Ozberk
authors.initials: OO
authors.lastname: Onur
authors.forename: Ozlem
authors.initials: O
authors.lastname: Guneysel
authors.forename: Murat
authors.initials: M
authors.lastname: Saritemur
authors.forename: Arzu
authors.initials: A
authors.lastname: Denizbasi