Management of patients with spontaneous rupture of hepatocellular carcinoma in a single centre is reported and the diagnosis and treatment are discussed. The clinical presentations, diagnosis and treatment of 28 cases of spontaneous rupture of hepatocellular carcinoma were reviewed. Twenty-six patients had sudden right upper-quadrant abdominal pain and 53.5% patients were in hypovolaemic shock on admission. The median survival of the patients who received one-stage, two-stage tumour resection and only transarterial embolization was 370, 483.5 and 60 days, respectively. The prognosis of the patients who underwent only conservative treatment or surgical haemostasis was poor. Transarterial embolization is the treatment of choice for those who are haemodynamically unstable on admission. Careful evaluations, including functional liver reserve, coagulopathy, tumour size and location should be made before tumour resection.