# A Rare Early-Onset Fatal Complication after Transarterial Chemoembolization: A Case Report and Review of the Literature

## TL;DR

An elderly patient with liver cancer experienced a rare and fatal complication after a common treatment, highlighting the need for better risk assessment and treatment strategies.

## Contribution

This case report identifies TACE-induced liver rupture as a rare but fatal complication and emphasizes the need for personalized risk assessment.

## Key findings

- An 82-year-old patient with HCC experienced liver rupture 20 hours after TACE, leading to multi-organ failure and death.
- TACE-induced HCC rupture is a rare complication requiring further study to establish optimal treatment approaches.
- Transarterial embolization (TAE) is currently favored for managing spontaneous ruptures, but no consensus exists for TACE-induced cases.

## Abstract

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.