Conservative Management of Bowel Injury Following Renal Cryoablation: A Series of Five Cases

Percutaneous cryoablation (PCA) is a minimally invasive treatment for small renal tumors, particularly in older or high-risk patients. Although rare, bowel injury is a recognized complication with the potential for severe outcomes. We report five cases (1.4%) of bowel injury among 363 PCA procedures performed between 2015 and 2023 at our institution. All injuries were confined to the retroperitoneum and managed conservatively without surgery. Mechanisms included ischemia, thermal injury, mechanical puncture, patient movement, and delayed abscess formation. Representative cases included a colorenal fistula that closed spontaneously and a renal abscess requiring drainage. Despite varied mechanisms, all patients were clinically stable with localized findings. Conservative treatment with antibiotics, fasting, and imaging follow-up was effective. No patients developed peritonitis or required surgical intervention. Conservative management may be appropriate for certain patients with bowel injuries after renal PCA, when the clinical condition is stable and the injury is anatomically confined.