Abstract
An 81-year-old woman with abdominal pain was brought by ambulance to our hospital. Abdominal contrast-enhanced computed tomography showed pneumatosis intestinalis and ascites. Non-occlusive mesenteric ischemia (NOMI) was suspected, and emergency surgery was performed. There was dark-red discoloration of the small intestine. Indocyanine green (ICG) fluorography to evaluate intestinal blood flow showed that mesenteric blood flow was maintained, but blood flow was absent in the discolored area of the intestinal wall. Intestinal necrosis associated with NOMI was diagnosed, and bowel resection was performed.
A single-stage anastomosis was avoided, and a second-look operation was performed the following day. Since ICG fluorography confirmed the absence of residual bowel ischemia, a small bowel anastomosis was performed. The patient was discharged home on postoperative day 17.
ICG fluorography is useful to accurately identify areas of necrosis during emergency surgery for NOMI and to evaluate any ischemia during second-look surgery. The utility of ICG fluorography to plan the treatment strategy in NOMI has rarely been reported. Therefore, this case is presented, and the relevant literature is discussed.
