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Updated: Sep 1, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Precise diagnosis of acute mesenteric ischemia using indocyanine green imaging prevents small bowel resection: A case
Kohei Furusawa1, Masanori Yoshimitsu1, Hiroyoshi Matsukawa1
1Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima-shi, Hiroshima-ken 730-8518, Japan.
Introduction:
Acute mesenteric ischemia (AMI) is a rare life-threatening condition that causes intestinal necrosis. Prompt intervention is essential to mitigate high mortality. In this report, we describe a case of AMI where precise diagnosis using indocyanine green (ICG) imaging to confirm sufficient bowel perfusion and viability, helped in preventing intestinal resection.
Presentation Of Case:
A 91-year-old male was diagnosed with AMI associated with superior mesenteric artery thrombosis using computed tomography and underwent exploratory laparotomy. Under white light, there was no outward evidence of small-bowel necrosis. Hence, ICG was used to confirm adequate bowel perfusion and viability. The operation was terminated without resection of the small intestine. When anticoagulation therapy was initiated postoperatively, the thrombus subsided. Although the patient had no subsequent recurrence, he died of dysphagic pneumonia two months after the surgery.
Discussion:
Physicians often choose to perform trial laparotomy to diagnose intestinal ischemia due to AMI. However, it was difficult to assess the viability of the entire intestinal tract using white light alone, and the introduction of ICG in the evaluation of intestinal perfusion will facilitate the identification and objective evaluation of the intestinal ischemic zone. There have been few reports on application of fluorescent-guided determination of the viable zone of the small intestine, which will help surgeons to make precise diagnosis.
Conclusion:
This case demonstrates ICG fluorescence imaging as a useful method for objectively assessing bowel viability.
Insights
Indocyanine green (ICG) imaging precisely confirmed bowel viability in acute mesenteric ischemia (AMI), a life-threatening condition. This technique helped surgeons avoid unnecessary intestinal resection, improving patient outcomes.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Medical Imaging
Background:
- Acute mesenteric ischemia (AMI) is a critical condition with high mortality, necessitating prompt diagnosis and intervention.
- Assessing bowel viability during surgery can be challenging with traditional methods like white light visualization.
- Indocyanine green (ICG) fluorescence imaging offers a potential solution for objective assessment of intestinal perfusion.
Purpose of the Study:
- To report a case where ICG imaging was used to determine bowel viability in a patient with AMI.
- To highlight the utility of ICG in preventing unnecessary intestinal resection.
- To emphasize the role of advanced imaging in surgical decision-making for AMI.
Main Methods:
- A 91-year-old male with superior mesenteric artery thrombosis underwent exploratory laparotomy for suspected AMI.
- Computed tomography (CT) confirmed the diagnosis, but visual inspection under white light did not reveal clear signs of necrosis.
- Indocyanine green (ICG) fluorescence imaging was employed to assess small bowel perfusion and viability.
Main Results:
- ICG imaging demonstrated adequate bowel perfusion, leading to the decision to avoid intestinal resection.
- The patient's condition improved postoperatively with anticoagulation therapy, and the thrombus resolved.
- No recurrence of ischemia was observed, although the patient later succumbed to pneumonia.
Conclusions:
- ICG fluorescence imaging provides an objective method for assessing bowel viability in cases of suspected intestinal ischemia.
- This technique can aid surgeons in making more precise diagnostic and therapeutic decisions, potentially reducing the need for extensive resections.
- The application of fluorescent-guided surgery represents a valuable advancement in managing acute mesenteric ischemia.
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