We report a 73-year-old man who underwent surgery for peritoneal dissemination of hepatocellular carcinoma (HCC) after percutaneous ethanol injection therapy (PEIT). He received posterior segmentectomy for HCC in 1997. Four years after the first hepatic resection, a recurrence lesion in the right caudal lobe of the liver was detected by computed tomography (CT). He underwent percutaneous ethanol injection therapy (PEIT) and transcatheter arterial embolization (TAE). He was referred to our hospital for further treatment. Abdominal CT revealed an early-enhanced lesion (3.2 cm in size) in the right caudal lobe of the liver and an irregular mass lesion (1.5 cm in size) in the cranial. We diagnosed the disease as recurrent HCC and carried out partial hepatectomy, removal of peritoneal dissemination and a reconstruction of the inferior vena cava. A histological feature of the tumor was a moderately differentiated HCC, and there was no lymphatic structure in the tumor, and no connection to the residual liver. Therefore, we diagnosed the tumor as peritoneal dissemination of HCC. We think that this is a rare but a serious complication of PEIT and every effort should be attempted to prevent this complication, especially in the treatment of superficial and larger HCC.