2021 Volume 41 Issue 6 Pages 409-416
NOMI is associated with multifocal and segmental intestinal ischemia, caused by vasoconstriction, and it is often difficult to precisely determine the area of bowel resection. In this study, we enrolled 51 patients who had undergone emergency surgery for NOMI between May 2012 and November 2020 at our institution. We performed intraoperative evaluation of bowel circulation using Indocyanine Green（ICG）fluorescence in 27 of the 51 patients. In order to study the usefulness of the ICG fluorescence method, we investigated the clinical variables in the survivor and non-survivor groups, and in the ICG fluorescence imaging and non-ICG fluorescence imaging groups. In addition, the findings of ICG fluorescence imaging and intraoperative findings were compared with the postoperative pathological findings. The data analysis revealed that postoperative onset of NOMI, preoperative serum lactate, and the SOFA score were significantly higher in the non-survivor group. Use of ICG fluorescence imaging allowed significantly shorter bowel resection, but had no influence on the prognosis. ICG fluorescence allowed identification of necrotic lesions that could not be identified by macroscopic examination in 7.4％ of cases. Necrosis and ischemia in the signal-deficient region on ICG fluorescence imaging were confirmed by the histopathological findings in all cases. ICG fluorescence imaging is a useful tool to determine the extent of intestinal resection in cases of NOMI.
