Successful treatment of non-occlusive mesenteric ischemia (NOMI) using the HyperEye Medical System™ for intraoperative visualization of the mesenteric and bowel circulation: report of a case

Nitori, Nobuhiro; Deguchi, Tomoaki; Kubota, Keisuke; Yoshida, Masashi; Kato, Ayu; Kojima, Masayasu; Kadomura, Tomohisa; Okada, Akihiro; Okamura, Juri; Kobayashi, Mariko; Sato, Takayuki; Beck, Yoshifumi; Kitagawa, Yuko; Kitajima, Masaki

doi:10.1007/s00595-013-0503-y

Cited by 38 publications

(23 citation statements)

References 7 publications

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“…However, only a surgical exploration is currently able to provide an accurate assessment of bowel viability and to delineate the frankly necrotic sections requiring segmental intestinal resection. On the other hand, partially ischemic bowel regions might be liable to salvage after intraoperative visualization of restored mesenteric perfusion, spontaneously or after injection of a fluorescent dye [22]. The presence of portal venous gas or pneumatosis intestinalis surely indicates urgent exploratory laparotomy.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of non-occlusive acute mesenteric ischemia in the intensive care unit

Bourcier

Oudjit

Goudard

et al. 2016

Ann. Intensive Care

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BackgroundNon-occlusive mesenteric ischemia (NOMI) is a common complication and accounts for a major cause of death in critically ill patients. The diagnosis of NOMI with respect to the eventual indications for surgical treatment is challenging. We addressed the performance of the diagnostic strategy of NOMI in the intensive care unit, with emphasis on contrast-enhanced abdominal CT-scan.MethodsThis was a retrospective monocenter study. Patients with clinically suspected acute mesenteric ischemia were included if a comprehensive diagnostic workup was carried out including surgical and/or endoscopic digestive explorations. Patients with evidence of occlusive mesenteric ischemia were excluded. A definite diagnosis of NOMI only relied on surgical or endoscopic findings. Abdominal CT-scans were reviewed by two radiologists blinded from the final diagnosis.ResultsA diagnosis of NOMI could be definitely confirmed or ruled out through surgical or endoscopic explorations of the digestive tract in 147 patients. With respect to their clinical characteristics, only a history of atrial fibrillation was an independent predictor of NOMI (odds ratio 8.3, 95% confidence interval 2.0–35.2, p = 0.004). Among them, 114 patients (75 with and 39 without NOMI) had previously been subjected to contrast-enhanced abdominal CT-scan. Portal venous gas, pneumatosis intestinalis and, to a lesser extent, abnormal contrast-induced bowel wall enhancement were poorly sensitive, but exhibited good specificities of 95, 85 and 71%, respectively. Nineteen out of 75 patients (25.3%) without any suggestive radiological signs finally exhibited mesenteric ischemia, including ten with intestinal necrosis.ConclusionsThe performance of abdominal CT-scan for the diagnosis of NOMI is limited. Radiological signs of advanced-stage ischemia are good predictors of definite mesenteric ischemia, while their absence should not be considered sufficient to rule out the diagnosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0213-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of non-occlusive acute mesenteric ischemia in the intensive care unit

Bourcier

Oudjit

Goudard

et al. 2016

Ann. Intensive Care

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“…The bright‐field/color fluorescence camera of the HyperEye Medical System® (Mizuho, Tokyo, Japan) has been used in gastroenterological surgeries to visualize sentinel lymph nodes and blood flow 24, 25.…”

Section: Discussionmentioning

confidence: 99%

Optimal timing of preoperative indocyanine green administration for fluorescent cholangiography during laparoscopic cholecystectomy using the PINPOINT® Endoscopic Fluorescence Imaging System

Tsutsui

Yoshida

Nakagawa

et al. 2017

Asian J Endoscop Surgery

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IntroductionThe PINPOINT® Endoscopic Fluorescence Imaging System (Novadaq, Mississauga, Canada) allows surgeons to visualize the bile ducts during laparoscopic cholecystectomy. Surgeons can continue operation while confirming the bile ducts’ fluorescence with a bright‐field/color image. However, strong fluorescence of the liver can interfere with the surgery. Here, we investigated the optimal timing of indocyanine green administration to allow fluorescent cholangiography to be performed without interference from the liver fluorescence.MethodsA total of 72 patients who underwent laparoscopic cholecystectomy were included in this study. The timing of indocyanine green administration was set immediately before surgery and at 3, 6, 9, 12, 15, 18, and 24 h before surgery. The luminance intensity ratios of gallbladder/liver, cystic duct/liver, and common bile duct/liver were measured using the ImageJ software (National Institutes of Health, Bethesda, USA). Visibility of the gallbladder and bile ducts was classified into three categories (grades A, B, and C) based on the degree of visibility in contrast to the liver.ResultsThe luminance intensity ratio for the gallbladder/liver, cystic duct/liver, and common bile duct/liver was ≥1 in the 15‐, 18‐, and 24‐h groups. The proportion of cases in which evaluators classified the visibility of the gallbladder and bile ducts as grade A (best visibility) reached a peak in the 15‐h group and decreased thereafter.ConclusionsIn the present study, the optimal timing of indocyanine green administration for fluorescent cholangiography during laparoscopic cholecystectomy using the PINPOINT Endoscopic Fluorescence Imaging System was 15 h before surgery.

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“…ICG fluorescence evaluation of blood flow has already been reported for superior mesenteric artery occlusion [7], strangulation ileus [8], and non-occlusive mesenteric ischemia [9].…”

Section: Discussionmentioning

confidence: 99%