A Case of Strangulated Intestinal Obstruction in Which Use of Indocyanine Green Intraoperative Fluorescence Angiography Allowed Avoidance of Extensive Intestinal Resection

Abstract

ICG fluorescence angiography using a near-infrared camera (ICG-FA) for intraoperative evaluation of blood flow in patients with strangulated intestinal obstruction (SIO) is drawing attention. The patient reported herein was a 42-year-old woman with neonatal hypoxic encephalopathy and its sequelae who presented to us with a 2-day history of abdominal pain and vomiting. We diagnosed her as having SIO with extensive intestinal ischemia based on the findings of abdominal contrast-enhanced computed tomography (CT) and performed emergency surgery. Intraoperatively, extensive torsion of the small intestine caused by adhesions at the jejunal origin and mesenteric root was observed. ICG-FA evaluation showed good fluorescence of the grossly dark red segment of the small intestine (White: W, 100 cm at the mouth) and also mosaic-like irregular fluorescence (Gray: G, 150 cm at the anorectal side). The mosaic-like irregular fluorescence (G, 150 cm anorectal side) was evaluated as a different type of fluorescence. The 50-cm segment of dark brown ileum on the anorectal side was rated as B, because it altogether lacked intestinal fluorescence. The 30-cm segment of G-assessed small intestine lacked sufficient blood flow from the vasa recta. We judged that the ischemic damage of the intestine in these two latter regions could not be reversed and performed partial intestinal resection of the 80-cm segment of ischemic intestine. The remnant intestine was preserved after 47 hours of two-stage surgery, and intestinal anastomosis was performed after partial resection of the G-assessed small intestine.