Umbilical disorders of foals

Question 1

Predisposing factors to patent urachus

Answer 1

Excessive umbilical traction e.g at birth
Local infection

Question 2

conservative vs surgical treatment of patent urachus basic

Answer 2

Conservative: dip in dilute iodine/leave alone
Surgical: done if it persists >7 days; = surgical removal of urachus or other umbilical remnants

Question 3

Surgical technique for patent urachus

Answer 3

Fusiform skin incision around umbilicus; dissect umbilicus and urachus out and follow caudally to the bladder
Clamp and resect the tip of the bladder here then close in two inverting layers using asorbable suture

Keep urinary catheter in for a couple days

Question 4

What to remember when suturing the bladder

Answer 4

Do not leave any suture in the lumen; can lead to stone formatino

Question 5

What are indications for surgical intervention with umbilical infection

Answer 5

Ultrasound shows widespread/severe infection
No response to antibiotics
Concurrent joint sepsis or widespread sepsis warrants immediate operation

Question 6

How are most umiblical infections dealt with

Answer 6

Medical treatment

Question 7

Technique for surgery on umbilical infection

Answer 7

Elliptical incision around umbilicus, dissect away from body wall
Incise linea alba cranially and caudally to umbilicus and dissect vein and arteries out until a point of normal diameter
Double ligate arteries and vein

Close body wall in 3 layers
Cover wound with stent or body bandage

Question 8

What can lead to ruptured bladder

Answer 8

Rapid and forceful parturition

Question 9

What is the priority when going into rupture bladder surgery

Answer 9

Dealing with the hyperkalaemia first

Question 10

Surgical treatment of ruptured bladder

Answer 10

Slowly drain abdomen of urine
Midline laparotomy; dissect around umbilicus and follow urachal stumb down

Usually find the tear on dorsal aspect of bladder hear neck so must retroflex
Excise tissue around tear and then oversew using two inverting continuous suture layers

Question 11

Where do we usually find bladder tears

Answer 11

On dorsal aspect near the neck

Question 12

Why do we drain the abdomen of urine slowly in a foal with rupture bladder

Answer 12

To avoid causing hypovolaemia

Question 13

How common are umbilical hernias

Answer 13

Relatively
~2% in thoroughbreds

Question 14

What are the issues with using elastrator rings to deal with hernias

Answer 14

Risk of gut getting trapped in ring if done standing
Once skin necroses, risk of leaving open hole into the peritoneum

Question 15

Surgical technique for dealing with umbilical hernia

Answer 15

Elliptical skin incision around hernial sac, leaving enough skin to close
invert the sac
Place mattress sutures with large metric absorbable suture e.g 5/6 metric PGA/PDS, ensuring no intestine is trapped before tickening

Close body wall
Add stent or body bandage

Question 16

Post-op care for umbilical hernia surgery

Answer 16

keep covered for 3-4 days, give NSAIDs, restrict exercise for 2-3 weeks and perhaps sedate when first turned out

Question 17

INguingal hernia cause

Answer 17

Congenital in foals likely hereditary
Related to enlarged vaginal ring
Most self-resolve in 6 months

Question 18

What signs of rupture/incarceration should we tell owners of foals with inguinal hernias to look out for

Answer 18

Cold-clammy feeling to scrotum
Colic/depression
Hernia becomes unreducible

With rupture, may see intestine travelled subcut

Question 19

What tends to cause inguinal/scrotal hernias in adults

Answer 19

Post-jumping or breeding
Usually non reducible and often strangulating

Question 20

What do we tend to do when dealing with hernia inguinal hernia in foals

Answer 20

Castrate at same time

Question 21

How to do an elective castration and hernia repair in foals

Answer 21

Closed castration, twisting vaginal tunic to milk any intestine back into the bdomen
Ligate as low as possible to prevent recurrence