February 24, 2011
Sometimes a newborn’s belly button doesn’t close.
By Dr. Justin Harper for American Association of Equine Practitioners, an AQHA alliance partner
The urachus is a tube that connects the bladder to the umbilicus, which normally should close in the newborn foal. However, sometimes this structure remains patent and becomes a problem. Continued dripping of urine or patency of urachal structures out through the umbilicus characterizes patent urachus.
It is sometimes thought to be normal in foals for up to three to five days of age. However, failure to close can lead to septicemia (blood infection), and medical or surgical procedures are recommended for correction. Medical and surgical therapies include systemic antibiotics, cauterization of the umbilical stump or surgical resection.
Sometimes antibiotic therapy allows final closure of the urachal structure; other times practitioners will use silver nitrate sticks to cauterize the area and promote closure.
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Yet if medical therapy is unsuccessful, surgical removal of the umbilical structures is recommended. This is performed by removing the remnants of the umbilical vein, arteries and the urachus itself. In order to completely remove the urachal structure, a cystotomy (incision of the bladder) has to be made and surgically closed. The bladder incision is closed, followed by the body wall incision. In general, surgical correction of a patent urachus is not an emergency procedure and has a very good prognosis post-operatively.
If a patent urachus is present, an ultrasonagraphic examination is warranted to evaluate all umbilical structures and identify any possible infection.
Septic Umbilicus (Omphalophlebitis)
Omphalophlebitis is an infection of any one or all of the umbilical structures (umbilical vein and arteries). This infection, if not treated appropriately, can lead to septicemia or an internal blood infection, which can seat bacteria to numerous locations throughout the body, most commonly a synovial structure (joint) or the respiratory tract (lungs).
Diagnosis is confirmed by typical appearance of umbilical stump (enlarged, warm, firm), elevated white blood cell count upon evaluation of systemic blood work and enlarged umbilical structures on ultrasonography exam of the umbilical structures.
Similar to patent urachus medical therapy, systemic antibiotics are recommended for foals that present with infected or septic umbilical structures. If medical antibiotic therapy is not successful within seven to 14 days, surgical resection is generally recommended.
Surgical resection involves removing all umbilical structures (umbilical vein and arteries, urachus) and performing a cystotomy (incision of the bladder). The bladder and body wall are closed after removal of the infected structures. Most foals generally remain on antibiotics for a specified period of time post-operatively. The prognosis is good for a septic umbilicus and is generally not an emergency procedure.
Umbilical hernias are congenital (present at birth) defects in the newborn foal characterized by a defect in the body wall. They can range from very small defects to extremely large defects (2 to12 cm). Umbilical hernias should be differentiated from umbilical infections by careful palpation. Some umbilical hernias can progress to strangulation of the intestine and cause severe signs of colic, however this is rare. Consulting with your veterinarian is recommended for both pathologies.
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Umbilical hernias are generally non-painful, non-firm (skin sack with intestines protruding through defect in the body wall), and can be reduced digitally with your fingers. Smaller hernias (2 fingers or less) are generally recommended to be reduced daily and often spontaneous close on their own as the horse becomes older (typically by 12 to 14 months of age).
Larger hernias or hernias that fail to close spontaneously can be repaired surgically or by placing a clamp over the hernia. Clamping umbilical hernias involves taking the skin and crushing it together over time causing the area to scar. This technique is not practiced commonly due to the complications potentially involved. A piece of intestine can become entrapped within the clamp, leading to a strangulating lesion resulting in severe colic and potentially death.
Surgical resection of an umbilical hernia can be performed using the closed or open technique. While the closed technique is less invasive (never entering the abdominal cavity), it has a higher percentage rate of failure, and repeat procedures are necessary. The open technique involves an incision into the abdominal cavity removing the inguinal sac and securing the two sides of the body wall and skin margins together. Surgical resection of umbilical hernias carries a good prognosis and is rarely an emergency procedure. Always consult your veterinarian for advice when trying to decide how to treat an umbilical hernia.
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