Intraoperative Assessment of Bowel Viability Using Indocyanine Green Fluorescence and Doppler Ultrasound in Incarcerated or Threatened Bowel Obstruction

Abstract

Incarcerated or threatened bowel obstruction with suspected intestinal ischemia requires prompt surgical intervention. This retrospective case series, involving 8 patients undergoing emergency laparotomy, evaluated the feasibility of combining indocyanine green (ICG) fluorescence and Doppler ultrasound for intraoperative bowel viability assessment. Indocyanine green was injected intravenously. Doppler assessment was performed using a high-frequency linear probe along the antimesenteric border. No patients required bowel resection. In 2 cases, initial ICG findings suggested non-viability, but Doppler ultrasound demonstrated preserved arterial flow. A second ICG injection showed fine granular fluorescence, allowing bowel preservation. The combination of modalities helped avoid unnecessary resections. Indocyanine green is safe and repeatable but limited by reduced signal in edematous tissue and subjectivity. Doppler ultrasound offers objective flow confirmation and may guide delayed reassessment. Despite a small sample size and selection bias, these findings support cautious, stepwise approaches in borderline cases and the need for multicenter prospective trials in emergency surgical settings.