Ruptured Peritoneal Dissemination of Hepatocellular Carcinoma Successfully Treated with Transcatheter Arterial Embolization: A Case Report and Literature Review

Rupture of peritoneal dissemination from hepatocellular carcinoma is a rare, life-threatening condition. A 66-year-old man who had previously undergone treatment for hepatocellular carcinoma presented with hemorrhagic shock due to a ruptured peritoneal nodule. Emergency transcatheter arterial embolization was performed. A triaxial system was used to navigate the tortuous omental artery. Successful hemostasis was achieved using an N-butyl cyanoacrylate-lipiodol mixture and gelatin sponge. A literature review identified only eight prior cases, revealing a mortality rate of 33.3%. Although surgical resection is often preferred because of preoperative diagnostic challenges and difficult arterial access, our case demonstrates that transcatheter arterial embolization using a triaxial system is a viable, minimally invasive alternative. Accurate identification of the feeding artery and strategic device selection are essential.