One uncommon but recognized presentation of hepatocellular carcinoma is with a hemoperitoneum. Hepatocellular carcinomas are often vascular and may present late with an acute abdomen and hemodynamic instability, as in this case with a large volume hemoperitoneum.

Alpha-fetoprotein (AFP) was performed after the event and was elevated, at 28 ng/ml.

The patient underwent catheter angiography and embolization with resultant hemodynamic stabilization.