Intestinal blood flow assessment by indocyanine green fluorescence imaging in a patient with the incarcerated umbilical hernia: Report of a case. (June 2016)

• Record Type: Journal Article
• Authors: Ryu, Shunjin; Yoshida, Masashi; Ohdaira, Hironori; Tsutsui, Nobuhiro; Suzuki, Norihiko; Ito, Eisaku; Nakajima, Keigo; Yanagisawa, Satoru; Kitajima, Masaki; Suzuki, Yutaka
• Is Part Of: Annals of medicine and surgery. Volume 8(2016)
• Page Start: 40
• Page End: 42
• Publication Date: 2016-06
• Subjects: Umbilical hernia -- ICG fluorescence -- Intestinal blood flow -- Case report; IBF intestinal blood flow -- ICG indocyanine green -- CT computed tomography -- NOMI non-occlusive mesenteric ischemia; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2016.04.020
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: After reduction of the incarceration during surgery for incarcerated hernia, intestinal blood flow (IBF) and the need for bowel resection must be evaluated. We report the case of a patient with incarcerated umbilical hernia in whom the bowel was preserved after evaluating IBF using indocyanine green (ICG) fluorescence. A woman in her 40s with a chief complaint of abdominal pain visited our hospital, was diagnosed with incarcerated umbilical hernia and underwent surgery. Laparotomy was performed to reduce bowel incarceration. After reducing the incarceration, IBF was observed using ICG fluorescence detected using a brightfield full-color fluorescence camera. The small bowel that had been incarcerated showed deep-red discoloration on gross evaluation, but intravenous injection of ICG revealed uniform fluorescence of the mesentery and bowel wall. This indicated an absence of irreversible ischemic changes of the bowel, so no resection was performed. The patient showed a good postoperative course, including resumption of eating on day 4 and discharge on day 11. In surgery for incarcerated hernia, ICG fluorescence may offer a useful method to evaluate IBF after reducing the incarceration. This case implied that PINPOINT could be used in open conventional surgery. Highlights: We have reported the case of a patient with incarcerated umbilical hernia. The small bowel that had been incarcerated showed deep-red discoloration. The bowel could be preserved after intraoperative evaluation of intestinal blood flow. The intestinal blood flow was evaluated by ICG fluorescence. PINPOINT, a brightfield color fluorescence camera was used for ICG fluorescence.