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Hepatic epithelioid hemangioendothelioma in a young nigerian presenting with massive hemorrhage: A case report and review of the literature

Hepatic epithelioid hemangioendothelioma (HEHE) is a rare sarcoma of vascular origin. Massive hemoperitoneum (due to spontaneous rupture) and hematemesis (due to hemobilia) are rarer manifestations of HEHE. We present a 22-year-old male with 6 weeks' history of worsening noncolicky right hypochondrial and epigastric pain that later became generalized. Initial clinical diagnosis of perforated duodenal ulcer was made. Emergency exploratory laparotomy revealed multiple hepatic and intraperitoneal tumors with hemoperitoneum. Histology of the biopsied masses revealed HEHE. He subsequently developed massive hematemesis secondary to hemobilia (which was confirmed at endoscopy) from the HEHE. Contrast-enhanced computed tomography done on account of rapidly increasing hepatomegaly demonstrated multiple peripherally enhancing hepatic masses and peritoneal nodules with hemoperitoneum. He was placed on Avastin-based chemotherapy because of the vascular proliferating nature of the tumor. Despite relatively stable postoperative period, our patient had repeated episodes of massive hemobilia and finally died after one cycle of chemotherapy.