{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T13:14:19Z","timestamp":1776777259754,"version":"3.51.2"},"reference-count":18,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Aim: Percutaneous liver ablation is a challenging procedure and operator-dependent. During the time when transarterial liver oncological therapies are favored over percutaneous liver ablation, we discuss the challenges of liver ablation with bowel interposition within the needle tract. Materials and Methods: In this IRB-approved retrospective review, we analyzed 481 cases of percutaneous microwave ablation performed between 2012 and 2025 using the NeuWave microwave ablation system with 15 or 20 mm probes under non-contrast CT guidance, with needle trajectories planned based on ultrasound. Dissection techniques were not performed, as intraprocedural ultrasound and CT assessment suggested that the ablation zone would remain confined to hepatic parenchyma. Cases of bowel transgression or close proximity were identified on post-procedural CT imaging, with a follow-up duration of 3 months performed consistently across all cases. Results: Three cases (0.6%) of bowel transgression or close proximity to bowel loops during needle placement were identified. There was no evidence of transmural bowel perforation or clinically significant bowel injury on clinical or radiologic follow-up. Post-procedural imaging demonstrated no free intraperitoneal air or fluid collections. Conclusions: In cases where the ablation zone is confined to hepatic parenchyma, bowel proximity to or inadvertent traversal by the cooled antenna shaft may not result in clinically significant injury and can be managed conservatively in selected patients.<\/jats:p>","DOI":"10.3390\/jcm15083171","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T11:42:45Z","timestamp":1776771765000},"page":"3171","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Accidental Bowel Transgression\/Close Proximity During Percutaneous Microwave Ablation of Liver Tumors: A Retrospective Case Series"],"prefix":"10.3390","volume":"15","author":[{"given":"Krish","family":"Vennam","sequence":"first","affiliation":[{"name":"Strong Memorial Hospital, University of Rochester, Rochester, NY 14642, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1552-1445","authenticated-orcid":false,"given":"George","family":"Ashji","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, University of Rochester, Rochester, NY 14642, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7543-7598","authenticated-orcid":false,"given":"Ashwani Kumar","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Imaging Sciences, University of Rochester, Rochester, NY 14642, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.1097\/HEP.0000000000000466","article-title":"AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma","volume":"78","author":"Singal","year":"2023","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/S1470-2045(24)00660-0","article-title":"Thermal ablation versus surgical resection of small-size colorectal liver metastases (COLLISION): An international, randomised, controlled, phase 3 non-inferiority trial","volume":"26","author":"Puijk","year":"2025","journal-title":"Lancet Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5375","DOI":"10.3748\/wjg.v26.i35.5375","article-title":"Gastrointestinal tract injuries after thermal ablative therapies for hepatocellular carcinoma: A case report and review of the literature","volume":"26","author":"Rogger","year":"2020","journal-title":"World J. Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1007\/s00270-023-03545-4","article-title":"Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA) to Improve Tumor Visualization, Navigation and Margin Confirmation in Percutaneous Liver Tumor Ablation","volume":"46","author":"Smits","year":"2023","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1007\/s00270-023-03508-9","article-title":"The Added Diagnostic Value of Transcatheter CT Hepatic Arteriography for Intraprocedural Detection of Previously Unknown Colorectal Liver Metastases During Percutaneous Ablation and Impact on the Definitive Treatment Plan","volume":"46","author":"Opperman","year":"2023","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1055\/s-0030-1261787","article-title":"Complications of radiofrequency ablation of hepatic, pulmonary, and renal neoplasms","volume":"27","author":"Howenstein","year":"2010","journal-title":"Semin. Interv. Radiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1148\/radiol.11091207","article-title":"Percutaneous ablation in the kidney","volume":"261","author":"Venkatesan","year":"2011","journal-title":"Radiology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e240694","DOI":"10.1001\/jamanetworkopen.2024.0694","article-title":"Integrating Navigation-Assisted Ablation in the Locoregional Treatment of Hepatocellular Carcinoma","volume":"7","author":"Iwai","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1109\/TBME.2006.884647","article-title":"Measurement and analysis of tissue temperature during microwave liver ablation","volume":"54","author":"Yang","year":"2007","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1055\/s-0034-1373789","article-title":"Complications of image-guided thermal ablation of liver and kidney neoplasms","volume":"31","author":"Kim","year":"2014","journal-title":"Semin. Interv. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1002\/cncr.23339","article-title":"Liver disease induced by radioembolization of liver tumors: Description and possible risk factors","volume":"112","author":"Sangro","year":"2008","journal-title":"Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1002\/hep.29207","article-title":"Prevention and treatment of complications of selective internal radiation therapy: Expert guidance and systematic review","volume":"66","author":"Sangro","year":"2017","journal-title":"Hepatology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e14157","DOI":"10.1002\/acm2.14157","article-title":"AAPM Medical Physics Practice Guideline 14.a: Yttrium-90 microsphere radioembolization","volume":"25","author":"Busse","year":"2024","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/j.acra.2010.03.005","article-title":"Microwave ablation: An experimental comparative study on internally cooled antenna versus non-internally cooled antenna in liver models","volume":"17","author":"He","year":"2010","journal-title":"Acad. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"111560","DOI":"10.1016\/j.ejrad.2024.111560","article-title":"Gastrointestinal tract perforation after radiofrequency ablation for hepatic tumor: Incidence and risk factors","volume":"177","author":"Gu","year":"2024","journal-title":"Eur. J. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1148\/radiol.2513081740","article-title":"Malignant liver tumors: Treatment with percutaneous microwave ablation--complications among cohort of 1136 patients","volume":"251","author":"Liang","year":"2009","journal-title":"Radiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1148\/radiol.2423052028","article-title":"Liver cancer: Increased microwave delivery to ablation zone with cooled-shaft antenna--experimental and clinical studies","volume":"242","author":"Kuang","year":"2007","journal-title":"Radiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1007\/s00270-011-0241-8","article-title":"Collaborative Italian Group using AMICA system. Complications of microwave ablation for liver tumors: Results of a multicenter study","volume":"35","author":"Livraghi","year":"2012","journal-title":"Cardiovasc. Interv. Radiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/3171\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T12:26:32Z","timestamp":1776774392000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/3171"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":18,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15083171"],"URL":"https:\/\/doi.org\/10.3390\/jcm15083171","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]}}}