Performing Indocyanine Green Fluorescence Angiography to Preserve the Vascular Supply of Pull-Through Tissue in Long-Segment Hirschsprung Disease: A Case Report

Abstract

A 9-month-old male infant diagnosed as having long-segment Hirschsprung’s disease with caliber change at the splenic flexure was admitted to our hospital for definitive surgery. He underwent a colostomy at 63 days of age. Definitive surgery was originally planned at approximately 6 months of age but was postponed due to COVID-19. We performed laparoscopic-assisted Swenson pull-through at 9 months of age. Our plan involved preserving the marginal artery in the pull-through tract and maintaining blood flow from the ileocolic or right colic artery while resecting the root of the middle colic artery. During surgery, the mesenteric vessels were difficult to recognize because of mesenteric fat. Therefore, we conducted indocyanine green (hereinafter referred to as “ICG”) fluorescence angiography to visualize the mesenteric arteries. After resecting the mesentery, the blood flow of the pull-through tract was confirmed by ICG fluorography. Subsequently, coloanal anastomosis was performed. Currently, at 3 months after surgery, the patient is progressing without notable complications. ICG fluorography can be useful for preserving blood flow in the pull-through intestinal tract when the identification of mesenteric blood vessels is difficult.