Massive non-functioning Adrenocortical carcinoma presenting as acute abdomen without rupture: A case report.

Adrenocortical carcinoma (ACC) is a rare, aggressive malignancy with diverse clinical presentations. Acute abdomen is an exceptionally uncommon manifestation, typically reflecting tumor rupture. We report a 39-year-old male presenting with acute abdominal pain and a palpable left upper-quadrant mass. Imaging demonstrated a massive adrenal tumor (17.8 × 15.1 × 20.2cm). En-bloc resection with negative margins was achieved without rupture while preserving adjacent organs. Histopathology confirmed ACC. The patient remains disease-free 36 months postoperatively without adjuvant therapy. Acute abdomen can be the presenting symptom of ACC even without tumor rupture. Timely intervention can prevent possible impending rupture, enabling complete resection and favorable oncological outcomes.