(1) Causes of primary liver cancer spontaneous rupture and bleeding is a common and serious complication of liver cancer. The mechanism of spontaneous rupture and bleeding of hepatocellular carcinoma is not completely clear, but may be related to the following factors: (1) high malignancy and rapid growth of hepatocellular carcinoma may lead to the relative lack of blood supply to the tumor, resulting in central ischemia, necrosis and liquefaction. (3) After the portal vein is embolized by the cancer embolus, the superficial peripheral part of the tumor becomes dystrophic necrosis and ulceration, which may also lead to bleeding; (4) When the tumor is located in the superficial position of the liver septum, it is easy to be impacted by external force. (2) Clinical manifestations and diagnosis Patients mostly visit the clinic with acute epigastric pain, which is mostly epigastric pain at the beginning, with sudden onset accounting for most of the cases. It is also accompanied by dizziness, cold sweat, nausea, vomiting and other manifestations. In the case of spontaneous rupture and bleeding of hepatocellular carcinoma, there are also cases where the abdominal pain is limited to the upper abdomen and is milder. Most patients may have pale face, cold extremities, cold sweat, fine pulse and decreased blood pressure. The abdominal pressure pain varies depending on the degree of cancer rupture. For small rupture and small amount of bleeding, the abdominal pressure pain can be limited to the lesion or is not obvious; for large rupture and large amount of bleeding, the whole abdominal pressure pain is present, and some patients may have rebound pain and abdominal muscle tension. When the bleeding is large, abdominal distension is seen, abdominal percussion is solid, mobile turbid sounds are positive, bowel sounds are reduced or absent, and blood tests may show decreased hemoglobin, increased total leukocytes and neutrophils. Ultrasound and CT also play an important role in confirming the diagnosis of ruptured hepatocellular carcinoma. (C) Treatment In recent years, with the development of emergency intervention, transhepatic artery chemoembolization for ruptured hepatocellular carcinoma hemorrhage has been successfully reported in China, and transhepatic artery embolization can be performed if necessary. If the systemic condition is good and the lesion is limited, emergency dissection can be performed if the technical conditions are available, and partial hepatectomy, unilateral hepatic artery ligation, multi-point injection of anhydrous alcohol next to the tumor and radiofrequency treatment can be performed according to the investigation. If the amount of bleeding is small and the vital signs such as blood pressure and pulse wave are still stable, it is estimated that the tumor is impossible to be resected, and non-surgical treatment can be performed under close observation. In the case of ruptured hepatocellular carcinoma with rapid onset, large bleeding volume and shock, different plans should be formulated according to the specific condition while actively fighting against shock, and surgery is still the main treatment method. Local sutures and large omental tamponade sutures are often used for patients who cannot be surgically resected or who are in poor general condition and in critical condition. For patients with advanced hepatocellular carcinoma rupture or liver function Child-pugh grade C, surgical treatment is not considered, but symptomatic support is provided.