Role of indocyanine green fluorescence angiography in intestinal obstruction with uncertain ischemia: a case report.

INTRODUCTION: Intestinal obstruction is a common surgical emergency associated with significant morbidity and mortality, particularly when ischemic compromise is present. Indocyanine green fluorescence angiography (ICG-FA) has emerged as a promising tool for the objective assessment of intestinal perfusion, optimizing intraoperative resection decisions. CASE PRESENTATION: An 84-year-old male patient presented with intestinal obstruction secondary to adhesions following conventional cholecystectomy. Exploratory laparoscopy revealed an edematous and congested ileal loop with macroscopically uncertain perfusion. ICG-FA demonstrated homogeneous perfusion compatible with tissue viability, thereby avoiding unnecessary resection. The patient had a favorable outcome and was discharged home on postoperative day 2 without complications. DISCUSSION: ICG-FA provides an objective assessment of intestinal perfusion. Current evidence suggests that fluorescence patterns can predict tissue viability, overcoming the limitations of classical methods based on direct visualization of bowel loops. CONCLUSION: ICG-FA is a useful tool to guide conservative decisions in cases of uncertain intestinal viability, potentially reducing unnecessary resections.