OBJECTIVE Spontaneous rupture is an uncommon complication of primary hepatocellular carcinoma (HCC). There is no standard method of treatment, and most often treatment depends on the condition of the patient or the assessment by the surgeon. The aim of this study was to evaluate our experience of emergency laparotomy in the management of spontaneous rupture of HCC.METHODS Retrospective analysis documented 49 rupture HCC cases who received emergency laparotomy from Oct. 1990 to Oct. 2006.RESULTS Thirty-nine cases (79.6%) had a history of hepatitis and 39 cases (79.6%) were accompanied with liver cirrhosis. The most frequent manifestation which was present in 47 cases (95.9%) was sudden right hypochondrial or epigastric pain. Shock was seen in 40 cases (81.6%), and 42 cases (85.7%) had signs of peritonitis. The methods of operation were performed in the number of cases as follows: suture in 5; packing in 2; hepatic artery ligation in 4; hepatectomy in 21; microwave coagulation in 5;microwave coagulation combined with packing in 3; microwave coagulation combined with hepatic artery ligation in 9. Morbidity occurred in 11 cases (22.4%). The overall hospital mortality rate was 10.2%. The mean survival time was 8.8 months. The main causes of death were liver failure and massive variceal bleeding.CONCLUSION Spontaneous rupture of HCC represents a life-threatening condition with an overall poor prognosis. Laparotomy should be the first choice for treating HCC rupture if the proper conditions are present. Liver failure is the vital condition influencing the prognosis.