Radiofrequency ablation (RFA) was introduced as a local therapeutic approach for a variety of malignant diseases. This modality has been reported to be one of the most feasible image-guided techniques, which can even cure a small cancer with one session of ablation. Although this technique is generally considered safe, adverse events attributable to the procedure have often been reported. Recently, we experienced a case of ileus arising acutely after the completion of RFA in the treatment of a small HCC. Until now, reports on the occurrence of ileus after RFA are almost lacking. In this rare case, we discussed the possible cause of the adverse event with a brief review of relevant literatures.