A Case of Ischemic Colitis in which the Bowel was Preserved by Assessment of Indocyanine Green Fluorescence

Abstract

An 88-year-old man was taken to another hospital by ambulance complaining of abdominal pain, and abdominal computed tomography (CT) showed thickening of the descending colon wall and increased surrounding fat density, leading to a diagnosis of ischemic colitis. Post-admission, the abdominal pain worsened, melena appeared, and contrast-enhanced CT showed a reduced contrast effect from the transverse colon to the sigmoid colon. Necrotic ischemic colitis was suspected, and the patient was referred to our hospital. On arrival, the abdomen was board-like, and the blood lactic acid level was elevated ; emergency surgery was therefore performed. Laparoscopic observation showed that, though the colon was edematous, there were no signs on the serosal surface suggestive of necrosis. Indocyanine green (ICG) fluorescence showed that blood flow to the bowel was preserved, and it was determined that enterectomy was unnecessary. The patient's postoperative course was uneventful, and he was discharged on day 10. Emergency surgery is indicated for necrotic ischemic colitis, but its preoperative diagnosis is difficult, and in many cases, the decision on whether or not to operate is a struggle. In our patient, the assessment of intestinal blood flow by means of ICG fluorescence under laparoscopic observation was useful for determining the necessity or otherwise of enterectomy with minimal invasiveness, and this case is therefore reported together with a discussion of the literature.