Harnessing Indocyanine Green Fluorescence for Checking Intraoperative Patency of Splenorenal Shunt for Extrahepatic Portal Venous Obstruction

This case report discusses intraoperative indocyanine green (ICG) fluorescence angiography to confirm the patency of a proximal splenorenal shunt in an 11-year-old patient with extrahepatic portal venous obstruction. The patient, managed previously with endoscopic sclerotherapy and propranolol, experienced recurrent gastrointestinal bleeding, necessitating surgical intervention. A proximal splenorenal shunt was created following splenectomy, and portal pressures dropped significantly from 33 to 14 mmHg postshunt creation. ICG was injected intraoperatively to assess shunt patency, and fluorescence imaging using the Olympus VISERA ELITE III system confirmed proper blood flow through the shunt. This technique and portal pressure measurements validated the patency without using Doppler ultrasound. ICG angiography offers a reliable alternative for intraoperative vascular assessment, expanding its application in pediatric surgery. This report underscores the novelty of using ICG in pediatric shunt surgeries and its potential in various shunt procedures.