VM94 - Use of indocyanine in emergency surgeries with compromised intestinal perfusion

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Purpose/Background: Intestinal perfusion and viability have historically been assessed largely by the clinical eye, this method lacks objectivity and precision.

Where there are concerns for intestinal ischemic injury without absolute indications to intestinal resection, compromise can be appraised by real-time fluorescent analysis of perfusion1.

The use of indocyanine green (ICG) to evaluate perfusion in elective surgeries has increased in popularity, but its use in emergency surgery is less common and with few publications.

We want to show in videos the usefulness of ICG in emergency surgeries with compromised intestinal perfusion.

Methods/Interventions: We present 2 cases of emergency intestinal surgery with surgical approaches (open and laparoscopic) and different surgical decisions (surgery with or without intestinal resection), supported by the use of ICG.

Results/Outcomes: We present the first case of a 65-year-old male patient with intestinal obstruction demonstrated by CT scan. Laparoscopic adhesion lysis was performed, but the need for intestinal resection was raised. ICG 0.05 mg/kg + 10 cc of saline solution was injected and in < 29 seconds the affected intestine showed notable arterial inflow and venous outflow, very similar to the neighboring healthy intestine. It was considered that the ischemia was not irreversible and it was decided not to resect, ending the surgery. A satisfactory postoperative evolution and hospital discharge on the 4th postoperative day.

We then present a second case of a 65-year-old male patient also with intestinal obstruction demonstrated by CT scan. Open surgery was performed to release adhesions and a 115 cm long segment of intestine with inadequate perfusion was delimited after injecting ICG 0.05 mg/kg + 10 cc of saline solution (the ischemia was considered irreversible). Resection was performed with margins shown by ICG fluorescence and an ICG-guided anastomosis was performed. Postoperative progress was slow but uneventful. Hospital discharge was on the 10th postoperative day.

Conclusion/Discussion: ICG is a direct and objective tool to evaluate intestinal viability in emergency surgeries and supports the surgeon in the intraoperative decision-making process.

The use of ICG in emergency surgeries where intestinal perfusion is compromised can improve the quality with which surgery is performed and this can lead to a reduction in health costs for both the patient and the health system.