Indocyanine Green Fluorescence-Guided Small-Bowel Preservation af-ter Severe Blunt Mesenteric Injury; a Case Report

Assessment of bowel viability after severe mesenteric trauma can be difficult despite a macroscopically pink intestine. A 38-year-old man presented in hemorrhagic shock after falling down stairs. Laparotomy revealed an approximately 8 x 8 cm mesenteric defect with arterial bleeding. After ligation and repair, a 2-cm bowel segment depended on a 7-8-mm residual mesenteric bridge. Focal venous congestion raised concern despite preserved color and mesenteric pulsations. Resection of at least 10 cm was considered to obtain healthy anastomotic margins beyond the surrounding mesenteric contusion and hematoma. After approximately 20 minutes of observation, 15 mg of indocyanine green was administered intravenously. Fluorescence appeared later in the questionable segment than in adjacent bowel and subsequently became clearly visible; the delay was not quantified. Combined with conventional assessment, this finding supported bowel preservation. Recovery was uncomplicated, and the patient reported no complaints at follow-up more than one month after surgery. This case illustrates short-term bowel preservation with indocyanine green as an adjunct to surgical judgment; longer follow-up is needed to exclude delayed ischemic stricture.