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Updated: Jun 11, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Intraoperative indocyanine green fluorescence for precise resection of nonocclusive mesenteric ischemia: a case
Akihito Mizukami1, Shinji Furuya2, Koichi Takiguchi1
1First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan.
Background:
Nonocclusive mesenteric ischemia (NOMI) is characterized by intestinal ischemia caused by spasms in the peripheral intestinal vessels without organic obstruction in the main mesenteric vessels. NOMI can be fatal in case of delayed diagnosis and treatment. Although the use of indocyanine green (ICG) fluorescence in assessing intestinal viability during NOMI surgery is well recognized, there is a paucity of reported cases using this technique. Herein, we present a case of NOMI that was successfully managed through accurate diagnosis and resection of the ischemic intestines guided by ICG fluorescence.
Case Presentation:
An 81-year-old man presented with abdominal pain. Contrast-enhanced computed tomography revealed intrahepatic portal vein gas, superior mesenteric vein gas, and terminal ileal edema. Considering these findings, the patient was diagnosed with NOMI and emergency surgery was performed. Intestinal edema was observed 30 cm upstream of the terminal ileum without serosal discoloration. ICG fluorescence revealed areas of normal perfusion as well as mild and moderate hypoperfusion. The small bowel, including the hypoperfusion area, was resected. As no clinical signs of residual bowel ischemia were observed during the postoperative course, a second-look operation was deemed unnecessary. Intraoperative ICG fluorescence and histopathological findings indicated mucosal edema in the mildly hypoperfused area and mucosal necrosis in the moderately hypoperfused area.
Conclusions:
This case highlights the use of intraoperative ICG fluorescence in the disease. ICG fluorescence is invaluable in assessing the extent of bowel ischemia and guiding precise resection. Thus, future efforts should focus on identifying accumulation of cases and quantification of ICG fluorescence intensity to further improve diagnostic performance.
Insights
This case study shows how indocyanine green (ICG) fluorescence successfully guided the precise resection of nonocclusive mesenteric ischemia (NOMI). ICG fluorescence is valuable for assessing bowel ischemia extent and improving surgical outcomes in NOMI patients.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Medical Imaging
Background:
- Nonocclusive mesenteric ischemia (NOMI) is a critical condition involving intestinal ischemia due to vascular spasms, potentially leading to fatal outcomes if diagnosis and treatment are delayed.
- While indocyanine green (ICG) fluorescence is recognized for assessing intestinal viability in NOMI surgery, documented cases are scarce.
- This report details a successful NOMI management using accurate diagnosis and ICG-guided resection.
Purpose of the Study:
- To present a case of NOMI successfully managed with intraoperative indocyanine green (ICG) fluorescence guidance.
- To emphasize the utility of ICG fluorescence in accurately assessing the extent of bowel ischemia and guiding surgical resection in NOMI.
Main Methods:
- An 81-year-old male patient presented with abdominal pain, diagnosed with NOMI based on CT findings including portal and mesenteric vein gas.
- Emergency surgery was performed, where intraoperative ICG fluorescence identified varying degrees of intestinal hypoperfusion.
- Resection of the affected small bowel was performed, guided by ICG findings, and a second-look operation was deemed unnecessary due to favorable postoperative recovery.
Main Results:
- ICG fluorescence effectively differentiated areas of normal perfusion from mild and moderate hypoperfusion in the ischemic bowel.
- Histopathological analysis confirmed mucosal edema in mildly hypoperfused areas and mucosal necrosis in moderately hypoperfused segments.
- The patient experienced a successful recovery without signs of residual bowel ischemia, validating the ICG-guided surgical approach.
Conclusions:
- Intraoperative ICG fluorescence is a valuable tool for assessing the extent of bowel ischemia in NOMI.
- ICG fluorescence enables precise surgical resection, significantly improving outcomes in NOMI patients.
- Further research should focus on accumulating more cases and quantifying ICG fluorescence intensity to enhance diagnostic accuracy and clinical application in NOMI.
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