LA umbilical disorders

Umbilical infections

Umbilical infections are most commonly seen in calves. Camelids and foals can also present with umbilical infections; these animals tend to be much sicker and present at a younger age.

Umbilical structures. The “round ligament of the liver” is also known as the “falciform ligament”.

Normally the urachus dissolves and is not present at birth. The umbilical arteries turn into the round ligaments of the bladder. The umbilical vein becomes the falciform ligament (aka the round ligament of the liver).

Any of the umbilical structures can become infected (and not follow the normal patterns). Urachal infections are the most common; umbilical vein infections the least common.

Diagnostics

It is important to determine the size and nature of the hernia. How many fingers can be fit into it? Is it reducible or nonreducible? Some hernias are reducible but snug. In the situations in which you can’t the reduce the hernia but the animal doesn’t act sick, try placing the animal in dorsal recumbency. This tends to make it easier to feel the hernia ring and reduce the hernia. Ultrasound can be used to identify gaps in the body wall, enlarged umbilical structures and infection.

It is common to see both infection and hernia.

Treatment

Camelids and foals get very sick if the umbilicus is infected and are generally treated with systemic antimicrobial therapy.

Calves tend to have more chronic infections and are treated by removal or drainage of the infected structure. If possible, we remove the infected stalk without opening it or rupturing it.  In calves, open hernia repair* is preferred over closed repair to evaluate for any signs of infected umbilical structures or adhesions that might be hiding in the abdomen. The infected stalk is identified and, ideally, removed.  The infected component usually ends in a wider area that looks like a mushroom cap. This signifies the extent of the infection. Any vessel remnant proximal to that cap is usually solid and can be transected safely.

If the urachus is infected, it is best to remove the end of the bladder. Closing the bladder is easy, calves do not need large bladders and this ensures all infection is removed.

Calves with umbilical vein infections often have liver involvement. This makes them higher anesthetic risks and poor doers. At surgery, the infected structure often requires “marsupialization” rather than removal. The infection often extends into the liver and this means it cannot be readily cut out at surgery. Instead, the infected vein is moved to a smaller incision. At this site, the vessel wall is sutured to the skin edges to allow the infection to drain out.

In real life, it is easy to “pop” these structures at surgery. If the umbilicus is draining and/or the infected structure is adhered to the body wall, drainage of most of the pus minimizes the risk of peritonitis. Once the drainage has mostly resolved, surgery can be performed to remove the tract and remaining infected structures.  It is important to oversew or cover the drainage area at the time of surgery.

Calf hernias intro (consider this required viewing)- youtube link

*Open hernia repair- the hernial sac is opened for abdominal exploratory

Closed hernia repair – the hernial sac is inverted into the abdomen and is not opened.

Key Takeaways

  • Urachal infections are the most common form of umbilical infection in calves. Surgery to remove the stalk includes amputating the end of the bladder.
  • Close the bladder in 2 layers with suture patterns. Avoid suture in the lumen of the bladder (nidus for stone formation). 3-0 monocryl works well in foals, goats and other smaller patients.
  • Umbilical artery infections can usually be removed en bloc (cut after the mushroom cap and where the “artery” is thin. No blood flow to worry about.
  • Umbilical vein infections -> liver and have a poor prognosis. Surgery involves marsupialization.
  • Keep these animals on restricted exercise for 6-8 weeks to avoid recurrence of the hernia.
  • No matter what you read, don’t do a vest over pants or a Mayo mattress suture for these. continuous pattern is best!
  • Use suture material that will last the 6-8 weeks and use large enough (#1 or #2 PDS or nylon usually) suture

Supplemental Resources

Umbilical masses in calves, ACVS- nice review; client focused

Calf umbilical surgery,-nice details if you will be doing these in the future – save for your files

We do recommend continuous patterns for all 3 layers of the body wall closure. I also agree with her suture removal time (14 days) but really keep calves and foals restricted for much longer than 14 days. Think about it. How long does your suture last (PDS? Vicryl?) and how long does it take the body wall to heal (60 days for adult horse)? What can happen if they bounce in the time frame between when the suture is no longer strong and body wall is still weak?

Comparison anesthesia techniques in calves undergoing umbilical surgery, Vet Anes Anal 2012 – for future reference

More visual details for those of you interested: youtube link

 

License

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Large Animal Surgery - Supplemental Notes by Erin Malone, DVM, PhD is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.