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Fig 1: Transabdominal ultrasound image of left side of abdomen on initial presentation demonstrating an increase in free peritoneal fluid.
sensitive to penicillin, gentamicin, ceftiofur, trimethoprim– sulphonamides (TMS) and tetracyclines. Antibiotic treatment was changed to TMS (30 mg/kg bwt, per os, b.i.d.) on Day 7 post-admission. The gelding was discharged from hospital 24 h later and a further 10 days of treatment with TMS and a larvicidal dose of an anthelmintic were recommended.
Fig 2: Gross appearance of peritoneal fluid obtained by abdominocentesis at presentation.
fluid therapy was stopped. Repeat abdominocentesis performed 48 h post admission demonstrated a decrease in TNCC (8.5 9 109 cells/L) but increase in TP (3.5 g/L). On microscopic examination, approximately 77% mildly degenerate neutrophils containing moderate numbers of bacilli were present. Peritoneal lactate had decreased to 3.6 mmol/L. Repeat haematology demonstrated a normal WBC count (9.9 9 109 cells/L) with a mild to moderate left shift (16% band neutrophils) and moderate toxic changes. Fibrinogen was within normal reference range (3 g/L) and serum biochemistry was unremarkable. Conservative therapy was thus continued. Culture and sensitivity results on the sample collected at admission demonstrated the presence of Actinobacillus spp.,
One month post initial presentation One month after initial presentation, the gelding represented with similar signs of lethargy and inappetence. Ongoing mild colic signs were reportedly present since discharge from hospital. Despite a quiet demeanour, clinical examination was normal and routine bloodwork was unremarkable. Abdominal ultrasound revealed copious amounts of free peritoneal fluid. Seven litres of turbid, serosanguinous peritoneal fluid was drained from the abdomen. On cytology although TNCC had further decreased to 4.2 9 109 cells/L, an unusual profile of mostly lymphocytes with smaller numbers of nondegenerate neutrophils (11%), plasma cells and eosinophils was observed. No bacteria were seen on this occasion and bacterial culture was negative. Treatment with oral doxycycline (7.5 mg/kg bwt, per os, b.i.d.) was commenced and continued for 10 days given that the previously cultured Actinobacillus spp. was
sensitive to tetracyclines. Once daily treatment with oral firocoxib (0.1 mg/kg bwt, per os, s.i.d.) was also instituted. Clinical examination 5 days after discontinuation of
doxycycline treatment was normal. Repeat abdominal ultrasound, however, revealed a persistence in the high volume of peritoneal fluid with a similar cell count (TNCC: 4.2 9 109 cells/L; TP: 31 g/L) and cytological profile. No bacteria were seen. These findings combined with an increased triglyceride concentration (3.5 mmol/L) were consistent with a chylous effusion (Meadows and MacWilliams 1994). Approximately 30 L of peritoneal fluid was drained. Blood work performed on this occasion was relatively unremarkable, albeit a mild anaemia (RBC:
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