Mechanical bowel displacement to enable safe microwave ablation of a peripheral hepatic tumor in Chilaiditi anatomy

Hepatocellular carcinoma is a primary liver cancer that is often treated with locoregional therapies such as radiofrequency ablation, cryoablation, or microwave ablation. These locoregional treatments can pose risk of thermal injury to surrounding structures such as the gallbladder, stomach, and bowel when located adjacent to a target lesion. Safe locoregional therapy can be further complicated when a patient has an anatomical variant such as Chilaiditi’s anatomy. We describe a case using a blunt-tipped trocar needle to mechanically displace interposed bowel loops adjacent to a peripheral hepatocellular carcinoma in a patient with a Chilaiditi anatomical variation, thereby facilitating safe and therapeutic ablation of the suspected lesion without injuring the interposed bowel.