A case report: Complications of trans arterial embolization in managing ruptured hemorrhage of hepatocellular carcinoma

Abstract Background Hepatocellular carcinoma (HCC) rupture and hemorrhage is one of the critical emergencies in HCC, with a high mortality rate upon occurrence. The mortality rate after rupture and hemorrhage is nearly 25%, while the recurrence rate of bleeding is approximately 20%, with a mortality rate exceeding 50%. Even after bleeding cessation, related complications pose significant challenges for treatment. Case Presentation Here, we report a case of multi‐vessel rupture and hemorrhage in HCC, where initial hemostasis was successfully achieved via trans arterial embolization (TAE), but another vessel ruptured and bled again within 48 h. The total blood loss in this case was about 3300 mL, accompanied by severe complications such as infection, liver function deterioration, hepatic encephalopathy, and malnutrition. Additionally, we conducted a literature review on the mechanisms and treatment of HCC rupture and hemorrhage, aiming to provide insights and lessons for its diagnosis and management. Conclusion (1) After TAE for ruptured hepatocellular carcinoma with hemorrhage, it is still necessary to be vigilant against the possibility of secondary hemorrhage. During the TAE procedure, precise embolization should be achieved as much as possible to reduce liver function damage. (2) After ruptured hepatocellular carcinoma with hemorrhage, complications such as abdominal infection, hepatic encephalopathy, malnutrition, and deterioration of liver function need to be watched out for. Early identification and active intervention can help patients achieve better prognosis.