Indocyanine Green (ICG) for the assessment of splenic perfusion during laparoscopic splenic artery aneurysmectomy. A case report
- PMID: 35122425
Indocyanine Green (ICG) for the assessment of splenic perfusion during laparoscopic splenic artery aneurysmectomy. A case report
Abstract
Case report: We describe the case of a 54-year-old man with a 20mm splenic aneurysm, who underwent laparoscopic aneurysmectomy, without splenic removal. The residual splenic blood supply was assessed by using indocyanine green i.v. administration.
Clinical findings: The patient presented at ED with abdominal pain, syncopal episode, and tachycardia. A CT scan with contrast showed hemoperitoneum with a 20mm splenic aneurysm, which was located at the bifurcation of the splenic and left gastroepiploic artery. Treatment and Outcome Laparoscopic surgery was then warranted. Abdominal exploration revealed a serohemorrhagic collection without active source of bleeding. After opening the gastro-colic ligament and obtaining vascular control of the splenic artery, the aneurysm was clipped and resected. No macroscopic modifications occurred to the spleen. This finding was confirmed by intravenous administration of indocyanine green. The operating time was 265 minutes. During the postoperative course, a grade A pancreatic fistula occurred. The patient was discharged on postoperative day seventh.
Clinical relevance: The management of true splenic artery aneurysms should be patient-tailored, considering the location of the aneurysm, operative risks and the patient's age, life expectancy and clinical status. The use of ICG in splenic surgery helps delineate the splenic parenchyma and evaluate residual splenic vascularization.
Key words: Indocyanine Green, Laparoscopy, Mini-invasive Surgery, Splenic Artery Aneurysm.
Un’adeguata gestione degli aneurismi dell’arteria splenica richiede una attenta valutazione della posizione dell’aneurisma, dei rischi operatori, dell’ età e dello stato clinico del paziente. L’uso del verde di indocianina nella chirurgia splenica aiuta a valutare il parenchima splenico e la vascolarizzazione residua. Riportiamo il caso di un uomo di 54 anni giunto in pronto soccorso con dolore addominale, episodio sincopale e tachicardia. La TAC con mezzo di contrasto evidenziava emoperitoneo con un aneurisma splenico di 20 mm, localizzato in sede perilare. Vista la stabilità emodinamica, il paziente veniva sottoposto ad esplorazione laparoscopica, in cui si evidenziava una raccolta sieroemorragica senza segni di sanguinamento attivo. Dopo aver aperto il legamento gastro- colico e ottenuto il controllo vascolare dell’arteria splenica, l’aneurisma è stato resecato. Non sono state identificate modifiche macroscopiche alla milza. Tale reperto è stato confermato anche dalla somministrazione endovenosa di verde indocianina. Durante il decorso postoperatorio, è comparsa una fistola pancreatica di grado A, risoltasi con la sola terapia medica. Il paziente è stato quindi dimesso in settima giornata postoperatoria.