Abstract Background Emergency bowel surgery presents an elevated risk of anastomotic leaks, attributed to factors such as comorbidities, sepsis, and inadequate pre-operative optimization. This heightened risk often results in a greater likelihood of stoma formation, which can lead to significant patient distress. This study aimed to assess the efficacy of Indocyanine Green (ICG) as a predictor for bowel resection and stoma requirement in emergency general surgery. Methods A systematic search was conducted on Embase and PubMed using the keywords: ICG, emergency, surgery, bowel, ischemia, and perfusion. Out of 266 articles identified, 32 original studies were included for analysis. Results A total of 308 individual cases were evaluated. Intra-operative visual findings were consistent with ICG perfusion results in 61% of cases (n=188). Two cases did not report ICG-intra-operative finding compatibility. In instances of discrepancy, ICG assessment led to altered surgical decisions in 47% (n=89) cases. Seven patients required further resection due to ongoing ischemia; notably, bowel resection was avoided in three patients despite ICG indicating poor perfusion. ICG predicted the bowel perfusion/viability in 302 cases, contributing to avoiding unnecessary resections in 21.7% (n=67) cases. Conclusion Our study showed that ICG can reliably indicate adequate bowel perfusion and therefore viability in 98% of emergency general surgery cases. ICG is a valuable predictor for the need for stoma formation in emergency surgical contexts. To explain the discrepancy between this result and reality, human decision-making bias is worth exploring.