Liver cancer is one of the major malignant tumors that seriously threaten people’s health in China. 85%-90% of liver cancer patients have varying degrees of cirrhosis. About 80% of patients have combined portal hypertension and about 30% have combined hypersplenism. The mortality rate of liver cancer in China is 20.4/100,000 people, accounting for about 1/2 of the world’s liver cancer deaths, and ranking second and first in the mortality rate of malignant tumors in rural and urban areas, which is very difficult to treat. Once a patient has hepatocellular carcinoma and portal hypertension with ruptured esophagogastric fundic varices and hemorrhage, treatment is much more difficult and the prognosis is often poor. Although some reports emphasize the possibility of simultaneous splenectomy, flow dissection and hepatectomy, in practice it is often very difficult to resolve portal hypertension and hepatocellular carcinoma with simultaneous surgery. In the case of a critically ill patient with massive hepatocellular carcinoma in the right posterior lobe who is also suffering from portal hypertension and hemorrhage from ruptured esophagogastric fundic varices, it is too risky for the patient to perform splenectomy, flow dissection and hepatectomy simultaneously. In this case, the greatest threat to life is the ruptured esophagogastric fundic vein bleeding, and the treatment should focus on hemostasis. During the operation, through multiple angiograms, the right posterior lobe hepatocellular carcinoma was successfully avoided in the process of establishing intrahepatic shunts, and hepatic artery chemoembolization was performed at the same time to effectively control the growth of hepatocellular carcinoma. After aggressive preparation, a precise hepatectomy was performed on the patient 8 days later, preserving the patient’s remaining liver tissue to the maximum extent. Habib 4X was applied during hepatectomy to dehydrate and coagulate the liver tissue on the proposed resected surface without blocking the blood flow into the liver, which significantly reduced bleeding during the resection and decreased the incidence of postoperative complications, making the hepatectomy process safer and faster. The intraoperative removal of the gallbladder prevented the patient from later acute calculous cholecystitis attacks and improved the patient’s quality of life; the common bile duct drainage prevented the occurrence of postoperative bile leakage from the hepatic section. Through the successful treatment of this case, we believe that for some critical patients with hepatocellular carcinoma combined with portal hypertension and ruptured esophagogastric fundic variceal bleeding, there is still hope to achieve a more satisfactory outcome by using precise sequential treatment strategies such as TIPS, TACE and Habib 4X assisted hepatic resection with proper indications.