Transarterial chemoembolization (TACE) is a minimally invasive treatment for liver cancer, often employed as a bridging therapy or destination treatment for non-operable cases. This case report discusses an 82-year-old woman with a large hepatocellular carcinoma (HCC) who underwent elective TACE due to the high surgical risk associated with her tumor size. Unexpectedly, the patient experienced liver rupture 20 h post-procedure, leading to acute surgical intervention. Despite successful hemostasis during surgery, the patient succumbed to progressive multi-organ failure. We aimed to search the PubMed database for documented cases of ruptured HCC after TACE. This study highlights risk factors for spontaneous HCC rupture and specific factors associated with TACE-induced rupture. Transarterial embolization (TAE) is currently favored as the treatment method for spontaneous ruptures, while the optimal therapy for TACE-induced ruptures remains unclear. In conclusion, this case underscores the importance of recognizing the rare complication of HCC rupture post-TACE and the need for personalized risk assessment. While TAE emerges as a primary treatment choice, the lack of consensus necessitates further studies to establish evidence-based approaches for managing this uncommon yet life-threatening complication.

中文翻译：

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经动脉化疗栓塞术后罕见的早发性致命并发症：一例报告及文献复习

经动脉化疗栓塞（TACE）是一种肝癌的微创治疗方法，通常用作无法手术病例的过渡治疗或目标治疗。本病例报告讨论了一位患有大肝细胞癌 (HCC) 的 82 岁女性，由于肿瘤大小相关的高手术风险，她接受了选择性 TACE。出乎意料的是，患者在手术后20小时出现肝脏破裂，导致紧急手术干预。尽管手术期间成功止血，患者还是因进行性多器官衰竭而死亡。我们的目的是在 PubMed 数据库中搜索 TACE 后 HCC 破裂的记录病例。本研究强调了自发性 HCC 破裂的危险因素以及与 TACE 诱发破裂相关的特定因素。经动脉栓塞（TAE）目前被认为是自发性破裂的治疗方法，但 TACE 引起的破裂的最佳治疗方法仍不清楚。总之，该病例强调了认识 TACE 后 HCC 破裂罕见并发症的重要性以及个性化风险评估的必要性。虽然 TAE 成为主要治疗选择，但由于缺乏共识，需要进一步研究来建立基于证据的方法来管理这种罕见但危及生命的并发症。