ICG fluorescence angiography is useful in guiding intra-operative surgical decision making in necrotizing enterocolitis

Abstract

Background: Necrotizing enterocolitis (NEC) is a devastating condition in premature babies and surgical resection of the necrotic bowels is often required. Herewith, we reported the application of Indocyanine green fluorescence angiography (ICG-FA) as a novel approach to assist intra-operative decision.Methods: Between July 2021 and June 2022, ICG-FA was used in 3 patients with severe NEC requiring bowel resection. Their clinical presentations and operative findings were presented.Results: All babies were born at or before 32 weeks of gestation and the body weight at operation ranged from 1.14 to 1.5 kg. NEC developed on day 7 to day 10 of life. In all patients, ICG at a dosage of 0.1 mg/kg was injected intravenously before bowel resection . In case 1,a baby with intra-operative diagnosis of NEC totalis, ICG-FA demonstrated bowel perfusion in 25 cm proximal jejunum that was regarded as necrotic by inspection. Case 2 was a baby with severe inflammation affecting the entire bowel. The indistinguishable boundary between inflamed and ischemic bowel was made clear with ICG-FA and a life-long end colostomy was avoided. In case 3, the decision for primary anastomosis was supported by ICG-FA showing adequate perfusion at the resected ends. In all cases, there was no adverse reactions reported.Conclusion: ICG-FA is helpful in intra-operative decision during surgery for NEC. It is safe and informative regarding the intestinal perfusion. It helps to promote a more precise bowel resection and facilitate primary anastomosis.