BACKGROUND: Emergency treatment for patients with a ruptured hepatocellular adenoma is controversial. The aim of this study was to evaluate management with selective arterial embolization. METHODS: The study included 11 consecutive patients treated for ruptured hepatocellular adenomas between 2001 and 2006. After initial haemodynamic support, all patients received selective embolization of branches of the hepatic artery. The primary outcome was effectiveness in stopping the bleeding. Secondary outcomes were complications and changes in tumour size after embolization. RESULTS: A single embolization brought haemorrhaging under control in ten patients; one patient needed three embolizations. None of the patients required emergency surgery. In the follow-up of 19 (range 7-49) months, no general or hepatobiliary complications were observed. All 25 adenomas, including those without signs of haemorrhaging in the same liver lobe, were either smaller or not detectable on computed tomography or magnetic resonance imaging after embolization, with the median diameter decreasing from 7.0 to 2.5 cm (P < 0.001). CONCLUSION: Selective embolization of the hepatic artery is a safe and adequate first approach in the management of patients with haemorrhaging hepatocellular adenomas. Furthermore, arterial embolization reduces the size of adenomas in the liver. Copyright (c) 2007 British Journal of Surgery Society Ltd.