Chyloabdomen in a cat with pancreatic carcinoma

Véran, Emilie; Gallay-Lepoutre, Julie; Gory, Guillaume; Guillaumot, Pierre; Duboy, Julie

rocedure tedious (Kim et al., 2011; Lee et al., 2012) . Laparotomy or more recently laparoscopy may be needed to perform the mesenteric injection (Brisson et al., 2006) . In this case report, an approach described by Ando et al. (2012) was applied. Ando et al. (2012) reported an appropriate visualization of the thoracic duct 5 minutes after contrast media injection in a healthy Beagle dog. Iwanaga et al. (2016) successfully used this protocol in a Shiba Inu suffering from thoracic duct rupture, with visualization of the duct 10 minutes after injection. In this cat, however, no interpretable visualization of lymphatic system was obtained, with only a few caudal lymph nodes detected. Failure of the lymphangiography in this case might be explained by species differences in absorption of subcutaneously injected contrast media, inappropriate dose of iodixanol, a different contrast media (iopamidol in the previous descriptions) or differences in the underlying disease responsible for chylous effusion. In human medicine, the precision of magnetic resonance lymphangiography images is improved if subjects have ingested a high fat meal 3-4h prior to examination rather than fasting (Chen et al., 2017) . It could have been a way to enhance lymphatic networks visualization in our case. Management of chyloabdomen first relies on treatment of the underlying cause when possible, as in this case pancreatic carcinoma. Pancreatic carcinoma is an uncommon tumor in cats with a high metastatic rate and a poor prognosis (Linderman et al., 2013) . Abdominal effusion is a negative prognostic indicator, with a median survival time of only 30 days (Linderman et al., 2013) . Gemcitabine is a nucleotide analogue used as a firstline agent in human pancreatic carcinoma (Teague et al., 2015) . It has been evaluated in cats alone or in combination with other drugs, like carboplatin or tyrosine kinase inhibitors (Martinez-Ruzafa et al., 2009; Linderman et al., 2013) . Chemotherapy provided an improvement of quality of life, but survival time remained poor, with a median of 165 days (Linderman et al., 2013) . Only four cats were reported to live longer than a year after diagnosis; all of them received gemcitabine-based chemotherapy (Martinez-Ruzafa et al., 2009; Linderman et al., 2013) . In our case, chemotherapy was declined, due to poor long-term prognosis. A palliative treatment with rutin and a low-fat diet was instaured. A low-fat diet may decrease the amount of fat in the effusion, which may improve the animal's ability to resorb fluid from the cavity (Hawkins and Fossum, 2009 ). Rutin is a benzopyrone flavonoid extracted from plants. The exact mechanism of action is unknown; it might reduce leakage from blood vessels, increase proteolysis and removal of protein from tissues, and enhance http://www.openveterinaryjournal.com E. Véran et al. Open Veterinary Journal, (2018) , Vol. 8(4): 452-457 ________________________________________________________________________________________________________ 456 macrophage phagocytosis of chyle (Meadows et al., 1993; Gould, 2004; Kopko, 2005) . In cats, it is recommended for management of idiopathic chylothorax (Gould, 2004; Kopko, 2005) and it was successfully used in a case of chylothorax due to cryptococcal mediastinal granuloma (Meadows et al., 1993) . By analogy, rutin has been unsuccessfully used in a case of chyloabdomen secondary to hypertrophic cardiomyopathy and a chylous pleural and peritoneal effusion with no underly