The gradual transition of cancer treatment delivery to an outpatient basis has caused a higher likelihood of problems occurring outside of the hospital, necessitating multiple acute care visits [1]. These crises encompass a diverse range of complaints that arise from the initial presentation of malignancy, the advancement of pre-existing disease, the recurrence, and the detrimental consequences of therapy [2]. Some of these emergencies can pose a significant risk to an individual's life.

Newly diagnosed malignancies manifest with an initial emergent presentation in approximately 11%−29% of patients [2]. These patients are characterized by lower one-year survival rates, higher rates of hospitalization, and diminished quality of life when compared to routinely detected cancers [3]. This may be because approximately 30% of cancers that manifest as emergencies are already associated with distant metastases, whereas only 14% of cancers that are diagnosed electively reveal the presence of distant metastases or other factors, such as the tendency to have a higher grade [4].

Patients with cancer may also present with nonspecific symptoms, such as diffuse gastrointestinal distress, or with negligible symptoms until a significant event occurs, for example hypotension serving as the initial manifestation of tumoral bleeding, either primary or secondary, due to therapy. Oncologic hepato-pancreato-biliary (HPB) emergencies can occur due to primary cancer, metastases, or post-treatment, such as operational intervention, locoregional treatment, or chemotherapy. The utilization of medical imaging is crucial in accurately identifying oncologic crises, significantly influencing the prioritization of patients for subsequent medical interventions [5]. The preferred imaging modality for assessing patients with an acute abdomen upon arrival to the emergency department is a contrast-enhanced computed tomography (CT) examination [6,7].

This narrative review aimed to highlight acute emergencies in patients with HPB cancers from both a diagnostic and some aspects of an interventional point of view.