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

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 there. The infected stalk is identified and, ideally, removed.

Calves with umbilical vein infections often have liver involvement. This makes them higher anesthetic risks and poor doers.

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 inverting 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. Appositional 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?

This study is one of my favorites:

Vet Surg. 1999 Nov-Dec;28(6):442-7.

Comparison of incisional bursting strength of simple continuous and inverted cruciate suture patterns in the equine linea albaMagee AA1Galuppo LD.

OBJECTIVE:To determine the bursting strength of ventral median abdominal incisions closed by either simple continuous or inverted cruciate suture patterns.

METHODS:A 25 cm ventral median incision was made through the linea alba and a 200 L polyurethane bladder was placed within the abdomen. Either a simple continuous or an inverted cruciate pattern using 3 polyglactin 910 with a bite size and suture interval of 1.5 cm was used to close linea incisions. Closure time was recorded for each pattern. The bladder was inflated with air at 40 L/min, and the pressure at body wall failure recorded. The length of suture used for wound closure and the wound failure modes were recorded. Deviation from the linea (cm), total suture length (cm), suture length to wound length ratio (SL:WL), closure time (min), bursting pressure (mm Hg), and failure modes were compared between groups using Welch-Aspin t-tests. The effects of independent subject variables were assessed for possible effects on bursting strength using analysis of covariance.

RESULTS:Mean bursting pressure was significantly greater for the simple continuous pattern than for the inverted cruciate pattern (P = .01). Significantly less suture material (P = .0002) was required with the continuous pattern than with the inverted cruciate pattern. Mean closure time, SL:WL, deviation from the linea, and failure modes were not significantly different between groups. No significant effects were noted for independent variables in both groups on bursting strength.

CONCLUSIONS:In this model, a simple continuous closure pattern for ventral median abdominal incisions was stronger than an inverted cruciate pattern. A simple continuous pattern leaves less foreign material in the wound, which may be of benefit in reducing incisional complications.

CLINICAL RELEVANCE:Use of a continuous closure pattern for the linea alba may offer greater wound security during episodes of increased intra-abdominal pressure in horses.

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

Icon for the Creative Commons Attribution-NonCommercial 4.0 International License

Large Animal Surgery - Supplemental Notes by Erin Malone, DVM, PhD; Elaine Norton, DVM PhD; Erica Dobbs, DVM; and Ashley Ezzo, DVM is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.