Acute haemoperitoneum due to small bowel metastases from hepatocellular carcinoma in a long term survivor following previous rupture

We report a 75-year old patient, presenting with acute abdomen and hemorrhagic shock. He provided history of right hemihepatectomy performed 5 years ago, for ruptured hepatocellular carcinoma on a background of Hepatitis B virus associated liver cirrhosis. A computerized tomography scan showed 5 cm-sized mass exophytic lesion, in the small bowel with haemoperitoneum. An emergency laparotomy and small bowel resection, with primary anastomosis was performed. Histology showed Hep Par 1 stain reactive cells, on the serosal surface of the small bowel. A final diagnosis of metastatic hepatocellular carcinoma was made.