A preventable cause of acute abdomen

Haemoperitoneum is an extremely rare presentation of hepatocellular carcino ma in the industrialised world. We present the first reported case in the U K. In contrast, up to 10% of hepatocellular carcinomas in Africa present in this way, the median time between presentation and death being just six we eks. Hepatitis B infection at birth and during childhood is the major cause of hepatocellular carcinoma in the developing world. The World Health Orga nisation, UNICEF and the World Bank have all advocated routine hepatitis B vaccination of children. This can reduce the burden of disease in these com munities, among people in their productive years of life.