ISSN 2398-2977      

Umbilical remnant infection

pequis

Synonym(s): Omphalitis (if all three remnant structures affected. NB ‘ Omphalophlebitis’ refers to infection of the umbilical vein; ‘omphaloarteritis’ to infection of one or both umbilical arteries, and ‘urachitis’ to infection of the urachus).


Introduction

  • Cause: umbilical cord contamination with bacteria during the birth process or shortly thereafter, may be secondary to abnormal separation of cord at parturition.
  • Signs: externally ranges from normal umbilical stump to enlarged stump with purulent discharge. Foal with patent urachus may also be at greater risk.
  • Diagnosis: physical examination, thickened vessels, possible history of other problems suggestive of dissemination of bacteria and evidence of abscessation on ultrasound examination of internal umbilical structures.
  • Treatment: antibiosis and/or surgical resection.
  • Prognosis: good if infection has not spread elsewhere / foal has not become septic Foal: neonatal septicemia syndrome.

Pathogenesis

Etiology

Predisposing factors

General

Specific

  • Dirty environment.
  • Manual separation of umbilical cord.
  • Lack of postnatal umbilical infection.

Pathophysiology

  • The umbilical cord of the foal consists of 2 arteries, 1 vein and the urachus. Normally at birth there is traction on the umbilical that causes it to break approximately 5 cm from the abdominal wall. The arteries retract approximately 6 cm into the abdominal cavity after natural breaking of the cord.
  • The umbilicus is one of the possible bacterial entries in the neonatal foal. In one study 25% of septic foals had umbilical infections, whereas 50% of foals with septic arthritis/osteomyelitis had concurrent umbilical infections.
  • Bacteria colonize the umbilical structures causing extraluminal and intraluminal inflammation and abscessation.
  • The urachus is the most common umbilical structure involved but the arteries and vein may also be affected.
  • In severe cases of umbilical vein infection, infection can track up to the liver and abscessation of the liver can occur.
  • Urachus may become patent post-birth in foals that strain excessively due to meconium impaction, uroperitoneum or other causes of abdominal discomfort. Once patent, urachus is at risk of becoming infected and developing an abscess.
  • It is common for more than one umbilical remnant structure to be involved due to their close anatomical relationships.

Timecourse

  • Umbilical structures are probably colonized at birth or during period of patent urachus.
  • In sick recumbent foals the umbilicus may not dry up normally and can be infected any time after birth.
  • Signs relevant to umbilical infection may appear within 24 h or may be latent for several weeks - most common in younger foals but can occur at any age.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Divers T J & Perkins G (2003) Urinary and hepatic disorders in neonatal foals. Clin Tech Equine Pract 2 (1), 67-78 VetMedResource.
  • Fischer A T Jr (1999) Laparoscopically assisted resection of umbilical structures in foals. JAVMA 214 (12), 1813- 1816 PubMed.
  • Lavan R P, Craychee T & Madigan J E (1997) Practical method of umbilical ultrasonographic examination of one-week old foals: the procedure and the interpretation of age-correlated size ranges of umbilical structures. J Equine Vet Sci 17 (2), 96-101 VetMedResource.
  • Edwards R B III & Fubini S L (1995) A one-stage marsupialisation procedure for management of infected umbilical vein remnants in calves and foals. Vet Surg 24 (1), 32-35 PubMed.
  • Reef VB, Collatos C (1988) Ultrasonography of umbilical structures in clinically normal foals. Am J Vet Res 49 (12), 2143-2146 PubMed.
  • Adams S B & Fessler J F (1987) Umbilical cord remnant infections in foals: 16 cases (1975-1985). JAVMA (3), 316-318 PubMed.
  • Doarn R T, Threlfall W R & Kline R (1987) Umbilical blood flow and the effects of premature severance in the neonatal horse. Theriogenology 28 (6), 789-790 VetMedResource.

Other sources of information

  • Neil K M (2011) Disorders of the Umbilicus and Urachus. In: Equine Reproduction. 2nd edn. Eds: McKinnon A O, Squires E L, Vaala W E & Varner D D. Wiley Blackwell. pp 632-637.
  • Nolen-Walston R (2006) Umbilical Infection/Patent Urachus. In: Equine Neonatal Medicine: A Case Based Approach. Ed: Paradis M R. Elsevier, USA. pp 231-236.
  • Lavan R et al (1994) Effect of Disinfectant Treatments on the Bacterial Flora of the Umbilicus of Neonatal Foals. In: Procs 40th Annual American Association of Equine Practitioners Conference. pp 63-65.

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