Equis ISSN 2398-2977
Urachus: patent
Synonym(s): Urachal fistula
Contributor(s): Jonathan Pycock, Wendy E Vaala
Introduction
- Cause: congenital and acquired forms of failure of the urachus to occlude at the umbilicus.
- Acquired types may be associated with systemic debilitation and/or umbilical infection.
- Signs: Presents within first 2 weeks of life with moist umbilicus and leakage of urine from the patent urachus.
- In acquired forms may be severe systemic signs in compromised neonatal foal.
- Diagnosis: history, signs.
- Treatment: is usually medical with antibiotic therapy, local umbilical cleaning/skin protection, possibly cautery, primary problem care and surgical resection of the umbilical remnants with persistent cases.
- Prognosis: guarded in systemically ill foals.
Pathogenesis
Etiology
Pathophysiology
Congenital urachus syndrome
- Urachus never closes at birth.
- Unknown etiology possibly due to distention from cord torsionin uteroor during delivery leading to tension of the umbilicus, dilation of the urachus and preventing occlusion.
Acquired urachus syndrome
- Re-opens post-partum as the dried umbilical stump falls off.
- Associated with umbilical infection/inflammation or excessive use of concentrated iodine dip resulting in premature sloughing of umbilical stump.
- Excessive wetness or trauma to the umbilical stump in the recumbent foal.
- Prolonged recumbency in debilitated foal.
- Poor/inexperienced cord ligation or severance. Ligature, if not removed may result in premature sloughing of stump.
- Any cause of increased intra-abdominal pressure, eg meconium retention Rectum: meconium impaction (tenesmus, dysuria etc).
- Urine leakage → persistent irritation and potential source of infection.
- Congenital forms are present at birth.
Timecourse
- Acquired forms develop in the first 2 weeks of life.
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.
- Smith M (2006)Management of umbilical disorders in the foal.In Pract28(5), 280-287 VetMedResource.
- Reef V B, Collatos C, Spencer P A, Orsini J A and Sepsey L M (1989)Clinical, ultrasonographic, and surgical findings in foals with umbilical remnant infections.JAVMA195(1), 69-72 PubMed.
- Reef V B and Collatos C (1988)Ultrasonography of umbilical structures in clinically normal foals.Am J Vet Res49(12), 2143-2146 PubMed.
- Richardson D W (1985)Urogenital problems in the neonatal foal.Vet Clin North Am Equine Pract1(1), 179-188 PubMed.
- Richardson D W & Kohn C W (1983)Uroperitoneum in the foal.JAVMA182(3), 267-271 PubMed.
- Ford J & Lokai M D (1982)Ruptured urachus in a foal.Vet Med Small Anim Clin77(1) 94-95 PubMed.
Other sources of information
- Barrelet A (1999)Investigation and management of foal umbilical disorders.In:Proc 38th BEVA Congress.pp8-10.