Radiofrequency Ablation for Unstable Ruptured Hepatocellular Carcinoma: A Case Report and Literature Review

Spontaneous liver bleeding is a rare but life-threatening complication of hepatocellular carcinoma (HCC). The optimal management strategy for this condition remains a topic of ongoing debate. We present the case of a 74-year-old man with cirrhosis and hemorrhagic shock resulting from the spontaneous rupture of HCC. Following a contrast-enhanced CT scan, the patient underwent emergency laparotomy. Hemostasis was attempted using conventional techniques but was unsuccessful. Due to unstable conditions (low blood pressure and high heart rate), poor liver function reserve, and a multifocal tumor, we decided to perform ultrasound-guided radiofrequency ablation (RFA) to achieve hemostasis. The patient was admitted to the ICU for early postoperative monitoring. On the second postoperative day, the patient returned to the surgical department. In most cases, interventional treatment is necessary to achieve hemostasis, even in patients with Child-Pugh C liver function. While transarterial chemoembolization followed by staged hepatectomy is considered the treatment of choice based on current clinical evidence, RFA is a viable alternative. In this case report, we demonstrate that RFA is a safe and effective technique for achieving hemostasis. It should be considered as an option for selected patients with ruptured HCC who are hemodynamically unstable, when embolization or resection is unavailable or unfeasible due to the patient's condition, or in cases of end-stage liver disease.