Equis ISSN 2398-2977

Umbilical cord: omphalophlebitis

Synonym(s): Omphalitis

Contributor(s): Virginia Buechner-Maxwell, Mary Rose Paradis

Introduction

  • Cause: umbilical cord contamination during the birth process, 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 and evidence of abscessation on ultrasound examination of internal umbilical structures.
  • Treatment: broad spectrum antibiotics and/or surgical resection.
  • Prognosis: good.

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, 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.

Timecourse

  • Umbilical structures are probably colonizd 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.

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.
  • Fischer A T Jr (1999)Laparoscopically assisted resection of umbilical structures in foals.JAVMA214(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 Sci17(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 Surg24(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).JAVMA1(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

  • Nolen-Walston R (2006)Umbilical Infection/Patent Urachus.In:Equine Neonatal Medicine: A Case Based Approach. Ed: Paradis M R. Philadelphia, Elsevier. pp 231-236.


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