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We present a case of a 69- year-old woman with acute cholecystitis and recent ERCP for choledocholithiasis who underwent hot laparoscopic cholecystectomy. Real-time NIR imaging demonstrated absent fluorescence in the cystic duct and gallbladder, indicating an obstruction. Palpation confirmed an impacted stone, which was milked back into the gallbladder, restoring fluorescence. Fluorescence guidance enhanced anatomical clarity and procedural safety despite significant inflammation. This case highlights the diagnostic value of ICG fluorescence in detecting cystic duct obstruction during complex emergency cholecystectomy.<\/jats:p>","DOI":"10.1177\/15533506261443016","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T05:00:39Z","timestamp":1776747639000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Use of Near-Infrared Indocyanine Green Imaging to Identify and Manage an Obstructing Cystic Duct Stone During Hot Cholecystectomy: A Case Report"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8599-2212","authenticated-orcid":false,"given":"Sanah","family":"Singh","sequence":"first","affiliation":[{"name":"Foundation Year Doctor, Poole General Hospital, University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Bonomo","sequence":"additional","affiliation":[{"name":"General Surgery, University Hospitals Dorset NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"National Institute for Health and Care Excellence (NICE). Cholecystitis \u2013 Acute: Management. Manchester: Clinical Knowledge Summaries; 2022. Available from. https:\/\/cks.nice.org.uk\/topics\/cholecystitis-acute\/management\/management\/"},{"key":"e_1_3_3_3_2","volume-title":"Gallstone Disease: Diagnosis and Management. Clinical Guideline [CG188]","author":"National Institute for Health and Care Excellence (NICE)","year":"2014","unstructured":"National Institute for Health and Care Excellence (NICE). Gallstone Disease: Diagnosis and Management. Clinical Guideline [CG188]. London: NICE; 2014. Available from. https:\/\/www.nice.org.uk\/guidance\/cg188\/evidence\/full-guideline-pdf-193302253"},{"key":"e_1_3_3_4_2","doi-asserted-by":"crossref","unstructured":"Hamid M Mirtorabi N Ghumman A et al. Tackling a Post-COVID-19 cholecystectomy waiting list: are we meeting the challenge? Medicina. 2023;59(10):1872. 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