INTRODUCTION : Spontaneous rupture of hepatocellular carcinoma (rHCC) is a life-threatening complication occurring in 3-15% of patients with HCC. This review discusses the most recent updates in the epidemiology, pathophysiology, risk factors, diagnosis and presentation, management, and prognostic factors of rHCC.

METHODS : A comprehensive systematic review was performed using MEDLINE/PubMed and Web of Science databases, with the end of search date being December 1, 2023, regarding rHCC diagnosis, imaging, and management.

RESULTS : Achieving adequate hemostasis and stabilization of the patient remains the primary objective in managing patients presenting with rHCC. In earlier studies, the mortality rate in the acute phase of rHCC has been reported to be 25-75%. However, more recent studies reviewed here have demonstrated that transcatheter arterial embolization/chemoembolization (TAE/TACE) followed by elective hepatectomy in select patients may offer significantly improved survival benefits and decrease perioperative complications compared to TAE/TACE alone or emergent/one-stage hepatectomy.

CONCLUSION : Although prognosis for rHCC remains the lowest among causes of death related to HCC, more recent studies have demonstrated that improved short- and long-term patient outcomes may be achieved through active surveillance efforts for HCC combined with advanced multimodal diagnostic tools and multidisciplinary management strategies.