A case of non-occlusive mesenteric ischemia with hepatic portal venous gas saved by two-stage surgery using ICG fluorescence imaging

Abstract

A 70-year-old man came to our hospital with a chief complaint of abdominal pain. An abdominal contrast-enhanced computed tomography （CT） scan revealed extensive hepatic portal venous gas and a poor contrast area in the small intestine, and he underwent emergency surgery. The patient was diagnosed as having non-occlusive mesenteric ischemia （NOMI）. The patient underwent small bowel resection with indocyanine green （ICG） fluorescence imaging and open abdomen management but without anastomosis. In 2nd surgery, the patient underwent anastomosis with ICG fluorescence imaging. The patient was discharged home on the 14th day without postoperative complications. We report a case of a patient with NOMI who underwent an optimal bowel resection using planned two-stage surgery and ICG fluorescence imaging, and had a favorable outcome.