Umbilical vein marsupialization in foals-short literature review

Umbilical remnant infections are common in neonatal foals and may involve one or more umbilical structures. Diagnosis relies on thorough clinical examination, ultrasonography, and hematologic evaluation. Standard care includes broad-spectrum antibiotics, with surgical resection if conservative therapy fails. Omphalophlebitis may extend to the liver, prompting consideration of umbilical vein marsupialization. Surgery is performed in dorsal recumbency with a fusiform incision around the umbilicus. The umbilical arteries and urachus are ligated and transected, with partial cystectomy when indicated, and the umbilical vein is mobilized cranially. Marsupialization is indicated when safe ligation and transection are not feasible, or when infection extends into the hepatic parenchyma. Cranial midline translocation incorporates the partially resected vein into the cranial celiotomy closure, limiting intra-abdominal contamination. However, this approach may predispose to surgical site infection and herniation, often necessitating a second surgery. In the right paramedian translocation technique, an additional paramedian incision is created for marsupialization; the stoma heals by second intention. Although this method carries a risk of contamination during exteriorization of the vein stump; protective, risk-mitigating strategies have been reported. Perioperative management includes broad-spectrum antibiotics, ideally guided by culture and sensitivity testing, along with wound care and, in some reports, flushing of the stoma. Prognosis is less favorable for foals requiring marsupialization-typically those with hepatic involvement-than for those undergoing simple omphalectomy, although favorable long-term survival has been reported. Despite limited and heterogeneous literature, umbilical vein marsupialization remains a viable surgical option in appropriately selected cases.