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Intraoperative angiography with indocyanine green injection for precise localization and resection of small bowel bleeding

AIM: Bleeding in the small bowel rarely occurs, and its treatment is challenging. Surgery is sometimes required in unstable patients; however, intraoperative identification of the bleeding site is extremely difficult. Many methods have been reported, but no standard strategy has been established yet...

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Autores principales: Kawachi, Jun, Ogino, Hidemitsu, Shimoyama, Rai, Ichita, Chikamasa, Isogai, Naoko, Murata, Takaaki, Miyake, Katsunori, Nishida, Tomoki, Fukai, Ryuta, Kashiwagi, Hiroyuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426192/
https://www.ncbi.nlm.nih.gov/pubmed/32817800
http://dx.doi.org/10.1002/ams2.549
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author Kawachi, Jun
Ogino, Hidemitsu
Shimoyama, Rai
Ichita, Chikamasa
Isogai, Naoko
Murata, Takaaki
Miyake, Katsunori
Nishida, Tomoki
Fukai, Ryuta
Kashiwagi, Hiroyuki
author_facet Kawachi, Jun
Ogino, Hidemitsu
Shimoyama, Rai
Ichita, Chikamasa
Isogai, Naoko
Murata, Takaaki
Miyake, Katsunori
Nishida, Tomoki
Fukai, Ryuta
Kashiwagi, Hiroyuki
author_sort Kawachi, Jun
collection PubMed
description AIM: Bleeding in the small bowel rarely occurs, and its treatment is challenging. Surgery is sometimes required in unstable patients; however, intraoperative identification of the bleeding site is extremely difficult. Many methods have been reported, but no standard strategy has been established yet. Here, we aimed to assess the safety and feasibility of intraoperative angiography with indocyanine green staining to accurately identify small bowel bleeding sites. METHODS: This retrospective study analyzed contrast‐enhanced computed tomography images of patients (n = 8) with small bowel extravasation who underwent surgery. If extravasation or other vessel abnormalities that were potential bleeding sites were detected on intraoperative angiography, a microcatheter was placed as close as possible to the extravasation site. Laparotomy was carried out, and 3–5 mL indocyanine green was injected through the microcatheter. The green‐stained segment of the small bowel was resected. RESULTS: Seven of the eight patients had positive angiographic findings and underwent bowel resection. The eighth patient had no abnormalities and hence did not undergo laparotomy. The rate of hemostatic success among the resected cases was 85.7% (six of seven cases). The resected specimens showed pathologic features in six of the seven patients (85.7%), all of whom achieved hemostasis. One patient had pneumonia and congestive heart failure that required longer hospital stay, but no mortality occurred. CONCLUSIONS: Intraoperative angiography with indocyanine green injection, followed by resection for massive small bowel bleeding is effective. This can be a therapeutic option for hemodynamically unstable patients.
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spelling pubmed-74261922020-08-16 Intraoperative angiography with indocyanine green injection for precise localization and resection of small bowel bleeding Kawachi, Jun Ogino, Hidemitsu Shimoyama, Rai Ichita, Chikamasa Isogai, Naoko Murata, Takaaki Miyake, Katsunori Nishida, Tomoki Fukai, Ryuta Kashiwagi, Hiroyuki Acute Med Surg Original Articles AIM: Bleeding in the small bowel rarely occurs, and its treatment is challenging. Surgery is sometimes required in unstable patients; however, intraoperative identification of the bleeding site is extremely difficult. Many methods have been reported, but no standard strategy has been established yet. Here, we aimed to assess the safety and feasibility of intraoperative angiography with indocyanine green staining to accurately identify small bowel bleeding sites. METHODS: This retrospective study analyzed contrast‐enhanced computed tomography images of patients (n = 8) with small bowel extravasation who underwent surgery. If extravasation or other vessel abnormalities that were potential bleeding sites were detected on intraoperative angiography, a microcatheter was placed as close as possible to the extravasation site. Laparotomy was carried out, and 3–5 mL indocyanine green was injected through the microcatheter. The green‐stained segment of the small bowel was resected. RESULTS: Seven of the eight patients had positive angiographic findings and underwent bowel resection. The eighth patient had no abnormalities and hence did not undergo laparotomy. The rate of hemostatic success among the resected cases was 85.7% (six of seven cases). The resected specimens showed pathologic features in six of the seven patients (85.7%), all of whom achieved hemostasis. One patient had pneumonia and congestive heart failure that required longer hospital stay, but no mortality occurred. CONCLUSIONS: Intraoperative angiography with indocyanine green injection, followed by resection for massive small bowel bleeding is effective. This can be a therapeutic option for hemodynamically unstable patients. John Wiley and Sons Inc. 2020-08-13 /pmc/articles/PMC7426192/ /pubmed/32817800 http://dx.doi.org/10.1002/ams2.549 Text en © 2020 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Kawachi, Jun
Ogino, Hidemitsu
Shimoyama, Rai
Ichita, Chikamasa
Isogai, Naoko
Murata, Takaaki
Miyake, Katsunori
Nishida, Tomoki
Fukai, Ryuta
Kashiwagi, Hiroyuki
Intraoperative angiography with indocyanine green injection for precise localization and resection of small bowel bleeding
title Intraoperative angiography with indocyanine green injection for precise localization and resection of small bowel bleeding
title_full Intraoperative angiography with indocyanine green injection for precise localization and resection of small bowel bleeding
title_fullStr Intraoperative angiography with indocyanine green injection for precise localization and resection of small bowel bleeding
title_full_unstemmed Intraoperative angiography with indocyanine green injection for precise localization and resection of small bowel bleeding
title_short Intraoperative angiography with indocyanine green injection for precise localization and resection of small bowel bleeding
title_sort intraoperative angiography with indocyanine green injection for precise localization and resection of small bowel bleeding
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426192/
https://www.ncbi.nlm.nih.gov/pubmed/32817800
http://dx.doi.org/10.1002/ams2.549
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