Hyperspectral imaging and indocyanine green fluorescence angiography in acute mesenteric ischemia: A case report on how to visualize intestinal perfusion

INTRODUCTION AND IMPORTANCE: Acute mesenteric ischemia is a challenging acute condition which is often caused by occlusion of an intestinal vessel. Therapeutic algorithms include revascularization of the occluded vessel and a surgical procedure to remove necrotic intestine. Sometimes necrotic intestine is hard to identify visually. Therefore, tools such as hyperspectral imaging (HSI) and indocyanine green fluorescence angiography (ICGFA) might be helpful for objective intraoperative evaluation of intestinal perfusion. CASE PRESENTATION: We present a case of an 80-year-old woman with an acute superior mesenteric artery occlusion and subsequent intestinal gangrene. After endovascular arterial revascularization, we performed an explorative laparotomy in which we assessed intestinal perfusion by HSI and ICGFA. Both HSI and ICGFA showed a sharp perfusion borderline in the proximal jejunum. The distal intestine showed low tissue oxygenation (HSI) and inhomogeneous perfusion (ICGFA). CLINICAL DISCUSSION: Both methods showed reproducible results for tissue perfusion and, thus, could provide additional information on the extent of necrotic bowel with need for resection. Therefore, both modalities might be used in future image-guided surgery in cases of acute mesenteric ischemia where visual discrimination of intestinal perfusion is challenging in order to resect as much bowel as necessary to improve patient outcome. Both methods exert different strengths: i.e. ICGFA is real-time angiography, whereas HSI may expose intestinal necrosis in spectroscopy. CONCLUSION: We show, for the first time, simultaneous imaging of HSI and ICGFA in a case of acute mesenteric ischemia. Both imaging modalities reveal similar results reliably concerning intestinal perfusion.