Spontaneous rupture of hepatic metastases leading to hemoperitoneum may initially present as collapse in the elderly and is a serious diagnosis. In this case report, we present a patient who was admitted following recurrent syncopal episodes with clinical features of persistent hypotension. A sudden fall in his hemoglobin level suggested that an acute bleed had led to his collapse. This was an important investigation finding in determining the cause of his syncopal episodes. The underlying diagnosis of acute hemorrhage from liver metastases was confirmed on computed tomography (CT) imaging.
An 85-year-old Caucasian man was admitted to hospital following three collapse episodes with transient loss of consciousness at home. Each episode was short-lived lasting several minutes. Apart from mild abdominal generalized discomfort, there were no other symptoms. There was no history of recent trauma. He had no history of similar episodes but was known to have severe aortic stenosis, type 2 diabetes, paroxysmal atrial fibrillation, hypertension and a previous duodenal ulcer bleed. At that time, he was taking aspirin, bisoprolol, omeprazole and ramipril. He lived with his daughter and was independent with his activities of daily living. He had not smoked for 35 years and his alcohol consumption was minimal.