Successful intestinal blood flow evaluation using indocyanine green fluorescent imaging in a case of small intestine strangulation: a case report

Abstract Introduction The assessment of intestinal blood flow using indocyanine green (ICG) fluorescence imaging is useful in ischemic bowel disease because it renders blood flow visible. Strangulated small intestine is a common postoperative complication requiring massive bowel resection, which can cause short bowel obstruction (SBO), a malabsorptive condition. Here, we report a successful case of preserving an ischemic intestinal segment while avoiding SBO based on the gap between the macroscopic findings and the ICG fluorescence imaging assessment. Case presentation A 46-year-old Japanese female patient who underwent an abdominal total hysterectomy and bilateral salpingo-oophorectomy with para-aortic lymphadenectomy due to small round cells of the left ovary was diagnosed with strangulated small intestine 1 month postoperatively. Macroscopic examination during the laparotomy revealed a strangulated small intestine with severe edema and dark red discoloration. However, this part of the bowel was preserved during surgery because the two-time administration of ICG solution revealed adequate perfusion. Conclusion This report reveals the effectiveness of ICG fluorescence imaging in intra-operative intestinal perfusion and its role in avoiding unnecessary massive resections. Combining these modalities may be effective for intra-operative bowel assessment; however, more accurate criteria and algorithms for evaluating blood flow and bowel perfusion should be established.