Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
Clin J Gastroenterol. 2022 Oct;15(5):886-889. doi: 10.1007/s12328-022-01656-y. Epub 2022 Jun 28.
We report the use of indocyanine green (ICG) fluorescence for intraoperative diagnosis in two cases of strangulated ileus. We successfully preserved the bowel and avoided postoperative complications by detecting adequate perfusion and no necrosis in the intestine's strangulated regions. In the first case, enhanced computed tomography (CT) revealed a closed loop intestine, which showed poor contrast, and we performed laparotomy with ICG fluorescence. In the second case, the CT scan revealed bowel obstruction without ascites. We conservatively treated the patient with the insertion of a long tube. The patient's condition did not improve, and we performed laparotomy using ICG fluorescence. In both of these cases, the visual observation during laparotomy showed that the ileum had dark-red discoloration. We demonstrated perfusion and preserved the ileum by injecting 2.5 mg of ICG intravenously; fluorescence was observed in the dark-red ileum using the PINPOINT system (Novadaq, Kalamazoo, MI, US). Both patients recovered successfully after the surgery with no adverse events. Our data suggest that ICG fluorescence imaging can be one of the decision-making modalities in patients with strangulated ileus.
我们报告了在两例绞窄性肠梗阻中使用吲哚菁绿（ICG）荧光进行术中诊断的情况。我们通过检测肠绞窄区域的充分灌注和无坏死，成功保留了肠管并避免了术后并发症。在第一例中，增强 CT 显示闭襻肠，造影不佳，我们进行了剖腹手术并使用 ICG 荧光。在第二例中，CT 扫描显示肠梗阻而无腹水。我们采用插入长管进行保守治疗。患者病情未见改善，我们使用 ICG 荧光进行了剖腹手术。在这两种情况下，剖腹手术时的视觉观察显示回肠呈暗红色变色。我们通过静脉注射 2.5mg ICG 来证明灌注并保留了回肠；使用 PINPOINT 系统（Novadaq，Kalamazoo，MI，US）观察暗红色回肠的荧光。两名患者手术后均成功康复，无不良事件发生。我们的数据表明，ICG 荧光成像可以成为绞窄性肠梗阻患者的决策模式之一。
