The malignant liver cell carcinoma is derived from liver cells, and the cholangio carcinoma is derived from the bile duct. The primary carcinoma of the liver are commonly associated with cirrhosis, and this ´relationship has been long" debated. It seems now certain that- carcinoma is associated with the postnecrotic and posthepatic types of´ cirrhosis. The carcinoma of the bile duct cell types are only infrequently associated with cirrhosis, and arise on the basis following long standing inflammatory fibrosis, cholelithiasis, and paracite infestation especially Clonorchiasis Sinensis in Asian conntries: The high incidences of the liver cell carcinoma have. been related to the Mycotoxic or Alatoxin which causes increased incidence of toxic liver iniries in some African countries. In addition, we emphasize that the highest incidence of liver cell carcinoma appears in countries where there is poverty, food scarcity, or tropical climate, all these factors tend to increase the amounts of fungal contamination which are responsible in forming Mycotoxin. Both the primary and mestastic carcinoma of the liver are more likely to occur at the right lobe of the liver. The mass of the hepatoma gradually incresed varying in siaes of a few milimiters to that of an eiitire lobe, and secondary changes with hemorrhage and central necrosis occur, infrequently developing an acute abdominal crisis characterized by intraperitoneal hemorrhage. Unforturenately an acute bleeding into the peritoneal cavity from the liver cell carcimoma is difficult to make diagnosis prior to exploratory laparotomy. The cases minic other conditions and presents an acute abdominal diseases. Four relatively well patients presented with sings of acute abdomen due to spontaneous rupture of the hepatoma. The unspected diagnosis were established at laparotomies.
1. The incidence of the primary liver carcinoma is about 4.5 to 8. 0%, but increased up to 30 to 50% in some countries in Africa.
2. An age incidence is betwene fifth and sixth decades, and has increasing incidence with age.
3. The primary and secondary liver carcinoma arise more frequently from the right lobe of the liver.
4. The primary carcinoma is classified commonly as liver cell and cholangio carcinoma, their ratio is 5 to 1.
5. The primary liver cell carcinoma has been associated with cirrhotic changes, and the highest incidence of carcinoma is seen in postnecrotic cirrhosis more than any types, of which incidence is about 50 to 80% of all cases.
6. The liver cell carcinomas have been associated with bleeding tendency in the Peritoneal cavity due to erosion of the engorged vessel or ruptured carinomatous nodules of the liver, incidence of with is about 2.8 to 15% of all ceses.
7. Operative mortalith of bleeding liver cell carcinomas 25% of all intraperitoneal hemorrhage. 8. In our cases of the liver cell carcinoma associated with massive bleeding into the peritoneal cavity, the average course from the first symptom to death was 6 to 10 months.
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