From intraoperative visual inspection to postoperative quantification: ICG fluorescence angiography for acute mesenteric ischemia validated by histopathology

INTRODUCTION: Acute mesenteric ischemia (AMI) is a rare and life-threatening condition that leads to intestinal necrosis. Accurate assessment of intestinal viability and perfusion is crucial for reducing its high mortality rate. CASE PRESENTATION: A 65-year-old female patient diagnosed with acute mesenteric ischemia complicated by intestinal necrosis underwent exploratory laparotomy. Under indocyanine green (ICG) imaging guidance, the necrotic bowel segments were resected. Postoperative quantitative analysis and histopathology confirmed intestinal necrosis. DISCUSSION: Due to the lack of specific appearance in the early stages of intestinal wall necrosis caused by acute mesenteric ischemia, relying solely on white light or subjective qualitative ICG fluorescence imaging makes it difficult to precisely define the resection margin. This case innovatively applied quantitative ICG fluorescence analysis, revealing a correspondence between specific perfusion parameters, including T0 and slope, and the histopathological grading of intestinal necrosis. These findings are consistent with trends reported in colorectal surgery, although differences in underlying pathophysiological mechanisms may limit comparability. Therefore, quantitative ICG may provide surgeons with an objective intraoperative decision-making tool. CONCLUSION: This case demonstrates that ICG fluorescence imaging combined with quantitative analysis may provide additional objective information for assessing intestinal viability.