title: Combination of diagnostic laparoscopy and intraoperative indocyanine green fluorescence angiography for the early detection of intestinal ischemia not detectable at CT scan.
abstract: BACKGROUND
  Acute mesenteric ischemia is the most severe gastrointestinal complication of acute aortic dissection. The timing of diagnosis is of major importance, in fact the recognition of acute mesenteric ischemia often occurs too late due to the presence of unspecific symptoms and lack of reliable exams. Recently, indocyanine green fluorescence angiography has been adopted in order to measure blood perfusion and microcirculation.
  
  
  METHODS
  We decided to perform a diagnostic laparoscopy with the support of intra-operative near-infrared indocyanine green fluorescence angiography, in order to detect an initial intestinal ischemia in a 68-year-old patient previously treated with a TEVAR procedure for a type-B aortic dissection. The fluorescence system demonstrated an hypoperfused area in the ascending colon, therefore an ileocholic resection was thus performed. Opening the operatory specimen, the mucosa of the colon appeared totally ischemic, whilst the serosa was normal.
  
  
  CONCLUSIONS
  When ischemia occurs, the oxygen supply is interrupted, hence the necrosis of the enteral mucosa occurs within 3h, whilst the necrosis of the full thickness of the bowel wall occurs within 6h. A diagnosis during these "golden hours" is of major importance for a successful treatment.
  
  
  CONCLUSIONS
  The combination of laparoscopy and UV light and fluorescein dye should be considered as an invaluable diagnostic procedure for the diagnosis of early stage acute bowel ischemia which is not visible at instrumental examinations nor with diagnostic laparoscopy.
authors.affiliation: General, Emergency and Minimally Invasive Surgery Unit, Careggi University Hospital, Florence, Italy. Electronic address: g.alemannomd@gmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Alemanno
authors.affiliation: General, Emergency and Minimally Invasive Surgery Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Somigli
authors.affiliation: General, Emergency and Minimally Invasive Surgery Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Prosperi
authors.affiliation: General, Emergency and Minimally Invasive Surgery Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bergamini
authors.affiliation: General, Emergency and Minimally Invasive Surgery Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Gherardo
authors.initials: G
authors.lastname: Maltinti
authors.affiliation: General, Emergency and Minimally Invasive Surgery Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Giordano
authors.affiliation: General, Emergency and Minimally Invasive Surgery Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Valeri
keywords: Case report; Indocyanine green fluorescence angiography; Intestinal ischemia; Laparoscopy