The assessment of intestinal blood flow using indocyanine green (ICG) fluorescence imaging is useful in ischemic bowel disease because it renders blood flow visible. Strangulated small intestine is a common postoperative complication requiring massive bowel resection, which can cause short bowel obstruction (SBO), a malabsorptive condition. Here, we report a successful case of preserving an ischemic intestinal segment while avoiding SBO based on the gap between the macroscopic findings and the ICG fluorescence imaging assessment.

Case presentation

A 46-year-old Japanese female patient who underwent an abdominal total hysterectomy and bilateral salpingo-oophorectomy with para-aortic lymphadenectomy due to small round cells of the left ovary was diagnosed with strangulated small intestine 1 month postoperatively. Macroscopic examination during the laparotomy revealed a strangulated small intestine with severe edema and dark red discoloration. However, this part of the bowel was preserved during surgery because the two-time administration of ICG solution revealed adequate perfusion.


This report reveals the effectiveness of ICG fluorescence imaging in intra-operative intestinal perfusion and its role in avoiding unnecessary massive resections. Combining these modalities may be effective for intra-operative bowel assessment; however, more accurate criteria and algorithms for evaluating blood flow and bowel perfusion should be established.

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