Purpose Cystic plate bleeding in patients with liver cirrhosis presents an extremely challenging diagnostic and treatment dilemma. Despite critical care support and/or aggressive surgical intervention, it carries high mortality and morbidity associated with rapid progression to end-organ dysfunction. We aim to highlight the current management of this rare phenomenon to aid surgeons from all settings, particularly in rural and regional Australia. Methodology A literature review was conducted on PUBMED and OVID to identify case reports and case series related to cystic plate bleed in patients with liver cirrhosis. Key words included “cystic artery bleed,” “haemorrhage,” and “liver cirrhosis”. Articles included detailed aetiology, stage of cirrhosis, presenting symptoms, diagnosis, management approach, and outcomes. Results Nine publications were identified, predominantly involving patients with alcohol-related advanced liver cirrhosis; one case had hepatitis C and HIV-associated cirrhosis. Cystic plate bleeding resulted from gallbladder varices or gallbladder perforation secondary to acute or chronic cholecystitis. However, some cases had spontaneous bleeds. Clinical presentation was non-specific and often mimicked symptoms related to decompensated liver disease. Despite intensive care support and aggressive surgical intervention, overall mortality was 70%. Survival was attributed to early recognition from identifiable precipitating factors, less advanced liver disease, and early liver transplantation. Conclusion The combined effects of severe coagulopathy and difficulty achieving haemostasis in oedematous and friable tissue planes make cystic plate bleeding in patients with cirrhosis a challenging surgical condition. Early recognition, prompt multidisciplinary involvement, including interventional radiology for minimal invasive approaches, may improve short-term outcomes; however, overall prognosis is largely linked to the severity of underlying liver disease.