Effectiveness of Intraoperative Indocyanine Green Fluorescence-Navigated Surgery for Superior Mesenteric Vein Thrombosis that Developed During Treatment for Intravascular Lymphoma: A Case Report
| Autor: | Hiroki Nakamoto, Kenji Yamada, Mitsuchika Hosoda, Hiromasa Namba, Koichi Taguchi, Ryoichi Yokota |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Indocyanine Green
Male Abdominal pain medicine.medical_specialty Lymphoma B-Cell Lymphoma Exploratory laparotomy medicine.medical_treatment Ischemia Fluorescence chemistry.chemical_compound Mesenteric Veins Laparotomy medicine Humans Aged Venous Thrombosis Intravascular large B-cell lymphoma business.industry Thrombosis General Medicine Articles medicine.disease Venous thrombosis chemistry Radiology medicine.symptom business Indocyanine green |
| Zdroj: | The American Journal of Case Reports |
| ISSN: | 1941-5923 |
| Popis: | Patient: Male, 70-year-old Final Diagnosis: Intravascular lymphoma • superior mesenteric vein thrombosis Symptoms: Abdominal pain Medication:— Clinical Procedure: Small intestine resection Specialty: Gastroenterology and Hepatology Objective: Unusual setting of medical care Background: Superior mesenteric vein thrombosis (SMVT) is a relatively rare form of acute abdominal disease; less than 0.1% of laparotomy surgeries are performed for SMVT. In the presence of severe intestinal ischemia or necrosis caused by SMVT, immediate surgical intervention is required. Macroscopic diagnosis of intestinal viability is sometimes difficult; its over-resection may carry the risk of short bowel syndrome. A near-infrared fluorescence imaging system with indocyanine green (ICG) has recently been developed for intraoperative, real-time evaluation of intestinal perfusion. This is the first report on the use of ICG fluorescence imaging during surgery for intestinal ischemia caused by venous thrombosis. Case Report: A 70-year-old man presented with a general feeling of weariness. On examination, he was diagnosed with intravascular large B cell lymphoma. R-CHOP therapy was initiated. On day 3 of initial R-CHOP therapy, the patient experienced sudden severe abdominal pain while in the hospital. Contrast-enhanced computed tomography revealed SMVT and loss of contrast effect in the small intestine. We diagnosed small bowel necrosis caused by SMVT, and exploratory laparotomy was performed, which revealed a continuous ischemia of 150 cm. Intraoperative ICG fluorescence imaging was utilized, and the color boundary was consistent with the ischemic area detected by visualization. The necrotic small intestine was excised and anastomosed. The patient was transferred to the hematology department on postoperative day 10 with no severe complications such as anastomotic leakage or re-thrombosis, and re-embolization was not observed 6 months later. Conclusions: Venous thrombosis should be listed as a differential diagnosis when acute abdominal disease presents during chemotherapy for malignant lymphoma. ICG fluorescence imaging may be useful in the evaluation of intestinal blood flow for venous thrombosis. |
| Databáze: | OpenAIRE |
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