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Microwave assisted liver resection is a useful technique, especially when haemostasis could be difficult to achieve with conventional methods. However, prolonged administration of microwaves can be responsible for intraoperative haemoglobinuria. We describe the first case of acute haemolysis secondary to microwave assisted liver resection. Case HistoryRadiofrequency assisted liver resection is nowadays a widely used technique both in open and laparoscopic surgery.1 Conversely, microwave assisted liver resection has been seldom reported. 2-4We describe a case of a 41-year-old patient who presented with sigmoid cancer and bilobar large liver metastases. He was treated initially with chemotherapy (FOLFOX + bevacizumab, 28 courses) but he developed complete portal vein thrombosis at the hilum. He also developed portal hypertension with superior mesenteric vein thrombosis, a low platelet count and hypersplenism, with a huge hypertrophy of segment I. His post-treatment computed tomography (CT) showed a significant reduction in size of the liver metastasis (Fig 1) with complete radiological and endoscopic response of the rectal tumour.However, the intrahepatic vascular shunts and the presence of portal hypertension were considered a contraindication for an extended hepatectomy and also risk factors for intraoperative bleeding. We therefore decided to resect the ONLINE CASE REPORT Ann R Coll Surg Engl 2014; 96: e1-e3