Umbilical hernias, umbilical abscesses, and urachal fistulas. Surgical considerations

Case report: Abdominal hernia repair using a surgical wire and an autologous omental graft in a Japanese Black calf

Background

Hernia formation is a well-known abdominal wall disorder in calves and most often occurs in the umbilical region. In addition, it occurs in the abdominal wall outside the umbilical region. It has been reported to involve acquired factors, such as external force to the lower or lateral abdominal wall, trauma, muscle weakness, and, although rare, congenital or hereditary factors. Although there have been reports on the repair of abdominal wall hernias caused by abnormal muscle formation, there have been no reports on the treatment of abdominal wall hernias caused by abnormal vertebral and rib formation in cattle or other ruminants. In this study, for the first time, we describe a case of successful closure of a hernia in the left flank caused by malformation of the vertebrae and ribs. The repair was performed by narrowing the ribs using a surgical wire and covering the defect with a free omental graft.

Case presentation

A male Japanese Black calf showed a mild bulge of the left abdominal wall and abnormal morphology of the left ribs immediately after birth. At 3 months of age, computed tomography revealed fusion of the 9th, 10th, and 11th thoracic vertebrae and missing formation of the 10th and 11th left ribs at the thoracic vertebral fusion site. Additionally, a 15.2 × 24.4 cm abdominal hernia had formed in the abdominal wall. During surgery, the ribs forming the hernia were narrowed with a surgical wire, and the hernia was covered with a large autologous free omental graft to prevent intra-abdominal organ prolapse. At the monthly follow-up (11 months after surgery), the calf had developed similarly to other calves of the same age on the farm, and no complications were noted.

Conclusions

The current case shows that a combination of rib correction using a surgical wire combined with transplantation of a free autologous greater omentum graft was shown to be a possible treatment option for surgical repair of large abdominal wall hernias caused by rib malformation.

Hernia formation after single‐stage umbilical vein marsupialization in three Percheron foals diagnosed with septic omphalophlebitis

Septic omphalophlebitis is a common disease process with a variety of morbidities and possible mortality. Affected umbilical remnant resection is highly successful but may not always be possible. Umbilical marsupialization can be implemented when total resection cannot be accomplished with minimally reported complications. Umbilical vein marsupialization was performed on three Percheron foals with extensive septic omphalophlebitis using the one‐stage paramedian translocation technique and prolonged postoperative antimicrobial therapy. Long‐term follow‐up revealed herniation at the marsupialization site in all foals. Two foals were subsequently treated with herniorrhaphy at the prior marsupialization site. One foal died due to septic peritonitis with hernia formation 3 months after marsupialization. This case series highlights hernia formation as a potential complication following one‐stage umbilical vein marsupialization in foals diagnosed with septic omphalophlebitis and should be considered as a possible postoperative complication.

Ultrasonographic evaluation of umbilical structures in Holstein calves: A comparison between healthy calves and calves affected by umbilical disorders

The aim of this study was to evaluate, during the first 4 wk of life, the involution of umbilical structures in clinically healthy calves and in calves affected by umbilical disorders, in both B-mode and color Doppler ultrasonography. The present study was carried out on 63 Holstein Friesian calves, divided into 3 different groups: group H (clinically healthy, n = 17), group A, (affected by omphaloarteritis, n = 24), and group V (affected by omphalophlebitis, n = 22). B-mode ultrasonography was performed at weekly intervals, using a portable device (LOGIQ Book XP, GE Healthcare, Little Chalfont, UK) and a linear multifrequency 7 to 10 MHz probe. In addition to the ultrasound examinations, the umbilicus of the calves was also evaluated using a color Doppler. The extra-abdominal as well as the intra-abdominal hemodynamics within the umbilical structures were evaluated using 3 different ranges of speed-flow detections (23, 14, and 7 cm/s). In healthy calves, as the age increased, the umbilical structures decreased in size and their ultrasonographic identification became more difficult. Conversely, in affected calves the umbilical structures did not show the same progressive reduction of external diameters and areas, but had an irregular trend of regression. Also the color Doppler ultrasonography showed a significant difference in frequency and percentage of speed-flow in the early days of examination between the 3 groups, with the most reliable results detected from the umbilical arteries. In our experimental study, omphaloarteritis could be detected at the d 1 color Doppler exam, with a 100% specificity and a 100% positive predictive value.

Comparison between open and closed methods of herniorrhaphy in calves affected with umbilical hernia

Umbilical hernias in calves commonly present to veterinary clinics, which are normally secondary to failure of the normal closure of the umbilical ring, and which result in the protrusion of abdominal contents into the overlying subcutis. The aim of this study was to compare the suitability of commonly-used herniorrhaphies for the treatment of reducible umbilical hernia in calves. Thirty-four clinical cases presenting to the Veterinary Teaching Hospital, Chittagong Veterinary and Animal Sciences University, Chittagong, Bangladesh from July 2004 to July 2007 were subjected to comprehensive study including history, classification of hernias, size of the hernial rings, presence of adhesion with the hernial sacs, postoperative care and follow-up. They were reducible, non-painful and had no evidence of infection present on palpation. The results revealed a gender influence, with the incidence of umbilical hernia being higher in female calves than in males. Out of the 34 clinical cases, 14 were treated by open method of herniorrhaphy and 20 were treated by closed method. Complications of hernia were higher (21%) in open method-treated cases than in closed method-treated cases (5%). Hernia recurred in three calves treated with open herniorrhaphy within 2 weeks of the procedure, with swelling in situ and muscular weakness at the site of operation. Shorter operation time and excellent healing rate (80%) were found in calves treated with closed herniorrhaphy. These findings suggest that the closed herniorrhaphy is better than the commonly-used open method for the correction of reducible umbilical hernia in calves.

Evaluation of cytologic and biochemical variables in blood, plasma, and peritoneal fluid from calves before and after umbilical herniorrhaphy

OBJECTIVE

To establish reference intervals for cytologic and biochemical variables in peritoneal fluid, whole blood, and plasma in calves with congenital umbilical hernias (CUHs) before and after herniorrhaphy and to assess whether those variables in calves with CUHs were altered, compared with findings in clinically normal calves.

ANIMALS

20 Holstein calves with or without a CUH. Procedures-10 calves with CUHs underwent herniorrhaphy. Blood and peritoneal fluid samples from all 20 calves were collected for cytologic and biochemical analyses on days 0 (before surgery), 1, 3, 5, 7, and 15. Data from the 2 groups were compared.

RESULTS

Reference intervals for the variables of interest were established for each group. Before surgery, calves with CUHs had significantly greater plasma total protein concentration and creatine kinase (CK) and aspartate aminotransferase activities and peritoneal fluid specific gravity values, compared with values for calves without CUHs. At various time points after surgery, peritoneal fluid total protein concentration; fibrinogen concentration; nucleated cell, polymorphonuclear cell, and lymphocyte counts; specific gravity; and lactate dehydrogenase, aspartate aminotransferase, and CK activities in calves with CUHs were significantly different from values in calves without CUHs. Some plasma and blood variables (eg, total protein concentration, neutrophil count, and CK activity) were significantly different between the 2 groups.

CONCLUSIONS AND CLINICAL RELEVANCE

Values of certain cytologic and biochemical variables in peritoneal fluid, blood, and plasma were different between calves with and without CUHs. Thus, determination of reference intervals for these variables is important for interpreting diagnostic test results in calves with CUHs.

Surgical abdomen of the calf

Although underrepresented compared with infectious diseases, calves' surgical abdomen diseases and abdominal surgery are a part of daily veterinary practice. Clinical presentations may differ from adult cattle and change rapidly. The decision whether to perform abdominal surgery or refer the animal has to take into consideration the condition and its prognosis for the calf. This article discusses clinical presentation of calves and focuses on specific situations with a detailed description of the surgical techniques, atresia coli, and umbilical remnants infection.

Risk factors for umbilical hernia in Holstein heifers during the first two months after birth

OBJECTIVE

To determine risk factors associated with identification of an umbilical hernia during the first 2 months after birth in Holstein heifers.

DESIGN

Case-control study.

ANIMALS

322 Holstein heifers born in a single herd (45 with an umbilical hernia and 277 without).

PROCEDURE

Risk factors that were examined included sire, whether the dam had a history of umbilical hernia, milk yield, duration of gestation, whether the dam had a history of dystocia, whether the heifer had a twin, birth weight, total serum protein concentration, and whether the heifer had an umbilical infection. Logistic regression was used to analyze risk factors.

RESULTS

Heifers born to sires with > or = 3 progeny with an umbilical hernia were 2.31 times as likely to develop an umbilical hernia as were heifers born to sires with < or = 2 progeny with an umbilical hernia. Heifers with umbilical infection were 5.65 times as likely to develop an umbilical hernia as were heifers without umbilical infection.

CONCLUSIONS AND CLINICAL RELEVANCE

Sire and umbilical infection were associated with risk of an umbilical hernia during the first 2 months of life in Holstein heifers. Attributable proportion analysis indicated that the frequency of umbilical hernias in Holstein heifers with umbilical infection would have been reduced by 82% if umbilical infection had been prevented.

Haemophilus somnus isolated from a urachal abscess in a calf

A urachal abscess was diagnosed in a 2-month-old, crossbred heifer that was presented for a distended abdomen and clinical signs of choking. Cultures of the mucopurulent exudate, obtained from within the mass on necropsy, yielded Haemophilus somnus. This is the first known documented report of H. somnus isolated from a urachal abscess.

Use of an endoscopic suturing device for laparoscopic resection of the apex of the bladder and umbilical structures in normal neonatal calves

OBJECTIVE

To develop a laparoscopic technique using an endoscopic suturing device for the resection of the apex of the bladder and the umbilical structures in large-animal neonates. Study Design-Experimental study. Animals or Sample Population-Seven healthy male Holstein calves.

METHODS

A laparoscopic technique for resection of the apex of the bladder was developed on 2 calf cadavers, then evaluated on 5 anesthetized calves. The calves were positioned in dorsal recumbency, and 4 ventral abdominal portals were used. The umbilical vessels were double-ligated using an endoscopic suturing device and subsequently transected. The apex of the bladder was transected between a row of laparoscopic clips applied near the apex and atraumatic laparoscopic forceps applied distally; then, the edges were apposed using an endoscopic suturing device. The dissected umbilical remnants were removed from the abdomen through a small incision centered at the umbilicus. One month later, the calves were euthanatized and a second-look laparoscopy performed; then, bladders were collected for gross and histologic examination.

RESULTS

No major complications occurred during or after surgery. The endoscopic suturing device permitted both effective ligation of the umbilical vessels and closure of the bladder. During second-look laparoscopy, healing of the peritoneal surface of the bladder and umbilical vessels was assessed to be excellent in 4 calves. A focal adhesion of omentum to the bladder suture line was observed in 1 calf. Focal adhesions of the omentum to the umbilical incision site occurred in 2 calves. The bladder mucosa was completely healed at the surgical sites.

CONCLUSION AND CLINICAL RELEVANCE

Resection of the apex of the bladder and umbilical vessels in calves can be accomplished laparoscopically using an endoscopic suturing device.