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Can an Intestinal Fluid Shift be a Predictor of Ischemic Injury?
*Abedalrazaq Alkukhun, *Armando Salim Munoz Abraham, Manuel I Rodriguez-Davalos, *John Geibel
Yale School of Medicine, Yale University, New Haven, CT

Objective: To create an ex-vivo intestinal ischemic model to further understand intestinal transplantation outcomes, and to correlate fluid shift seen in ischemic injury with histopathological analysis. Design: We procured intestinal segments from Male Sprague-Dawley rats and connected them to customized intestinal perfusion chambers that are part of a perfusion device. The lumens of both intestines were continuously perfused with a buffer solution containing 50µM Fluorescein isothiocyanate-Inulin (non-absorbable fluorescent marker). Both intestines on the vascular side were perfused with the same buffer solution; however, the experimental arm solution was bubbled with 100% Nitrogen gas to mimic an ischemic environment. Intraluminal samples were collected at 30-minutes intervals to measure FITC-Inulin concentration using nanospectrofluorimeter. Intestinal segments were sent for histopathological analysis at the conclusion of the experiment. Setting: Surgical Laboratory, Yale School of Medicine Patients: Rat model Interventions: The use of 100% Nitrogen bubbled solution surrounding the experimental arm to reproduce an ischemic injury to the intestinal tissue. Main Outcome Measures: Decrease in Intraluminal FITC-Inulin concentration as a measure of fluid shift produced by and indicative of intestinal ischemia, and histopathological grading of intestinal ischemia using Chiu/Park scale following perfusion. Results: There was a 50% decrease in FITC-Inulin concentration in the ischemic arm when compared to the control segment, indicating more fluid secretion stimulated by the ischemic environment. Histopathological analysis confirmed that the experimental arm was a grade 4 on the Chiu/Park scale compared to the control arm that was a grade 1. Conclusions: FITC-Inulin concentration measurement is a reliable volume marker that measures intraluminal shift that occurs during ischemic injury. It provides with a real-time evaluation of intestinal viability that is confirmed by histopathological analysis.

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