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Rupture of a Nodule of Hepatocellular Carcinoma Simulating Uterine Rupture in Late Pregnancy

CASE REPORT A 30-year-old unbooked grand multipara presented with a history of 8 months of amenorrhoea and 3 hours of generalized abdominal pain of sudden onset. She was found to be in shock, with cold extremities and severe conjunctival pallor. Her blood pressure was 70/40 mmHg and the pulse rate 92 beats per minute. The chest was normal. The abdomen was rigid, tender and showed rebound tenderness. The uterus measured 36 em from the pubic symphysis. Although the fetal parts could be felt, the fetal heart sounds were absent. There were no uterine contractions. A diagnostic abdominal parencentesis yielded frank unclotted blood. A working diagnosis of hypovolaemic shock secondary to massive intraperitoneal haemorrhage due to uterine rupture was made. Immediate resuscitative measures were instituted preparatory to an emergency laparotomy. At surgery, there was a massive haemoperitoneum but no evidence of uterine rupture. A caesarian section was performed with the deliveryof a fresh stillbirth. The source of bleeding was found to be a site of rupture on the inferolateral aspect of the liver which was diffusely nodular. An attempt was made to repair this rupture with omentum without success. She continued to bleed postoperatively