Predicting viability of ischemic small bowel using intraoperative indocyanine green fluorescence angiography

Abstract

We applied indocyanine green fluorescence angiography (ICG-FA) to a child with intestinal volvulus and assessed if ICG-FA could help judge bowel resection. ICG with a dose of 0.5 mg/kg was injected and decision of intestinal resection was made by means of the degrees of fluorescent intensity in fluorescence system. An 8-year-old girl was diagnosed as intestinal volvulus due to mesenteric defect with 200 cm of the strangulated intestine. ICG-FA revealed no fluorescence was observed at the entire strangulated intestine, thus we planned to re-evaluate the viability of intestine. ICG-FA at second look operation showed three patterns of fluorescent intensity including WHITE; strong fluorescence at mesentery and intestinal wall, GRAY; weak mosaic fluorescence at bowel wall, and BLACK; no fluorescence. We decided to resect 100 cm of BLACK fluorescent bowel and preserve WHITE and GRAY fluorescent intestine with double-barreled stoma. The 3rd ICG-FA reveled GRAY pattern changed to WHITE fluorescence, thus stoma was closed successfully. The patient is doing well 2 years after surgery without any complication ICG-FA can provide useful real-time visualization of intestinal perfusion intraoperatively, and help surgeon judge the necessity and its area of bowel resection.