Persistência de úraco em potra : relato de caso

Abstract

Witlin neonatology, some serious diseases can may bring the foal to death while mild graves one can be quickly reversed with clinic al therapy and/or adequate surgery. The persistence of urachus, which is a condition that affect neonates, either congenital or acquired and, if not treated correctly, can lead to problems such as septic arthritis, liver abscess, sepsis, among others. This work describes the clinical-surgical approach to the persistence of urachus in a foal referred to the Veterinary Hospital of the Federal University of Mato Grosso (UFMT) – campus Cuiabá. Case: An eight-day-old quarter mile foal was referred to the Veterinary Hospital of the Federal University of Mato Grosso, Cuiabá – MT, for surgical intervention of persistent urachus, due to non-resolution with conservative treatment. The clinical history reported by the responsible veterinarian showed that the birth was not assisted. It was performed an umbilical deeping with 10% iodine tincture, twice a day. The physiological parameters were within the normal range for neonates and the foal showed tendon contracture of the thoracic limbs, opting for clinical treatment using splints. On the third day of life, it was observed the leakage of urine through the navel during urination, indicating patent urachus, this change of topical umbilical therapy for systemic therapy. On the seventh day of life (5th day of treatment), despite the reduction in the flow of urine through the navel, the owner opted to refer the animal to the Veterinary Hospital for surgical intervention. The pre-anesthetic medication (MPA) procedure was butorphanol tartrate (Torbugesic®, 0.05 mg / kg / IV) and diazepam. After 10 minutes, an anesthetic induction was performed with ketamine hydrochloride with diazepam and maintenance with isoflurane. In the postoperative period there was no complications resulting from surgery, being made the suture removal on the tenth day with complete resolution of the case. The responsible veterinarian reported that the tendon contracture resolved by the use of splints. Discussion: The term persistence or patency of the urachus describes a failure in the closure and spontaneous regression of the urachus after birth, having as main complaint the leakage of urine through the navel. In this report, a persistence of urachus was observed at the end of the second day of the foal's life, characterizing an acquired condition, which is often a consequence of septicemia or umbilical bacterial infection. As the birth wasn’t assisted, there was no informations about possible problems or difficulties that would justify the occurrence of the disorder, such as, for example, early rupture of the umbilical cord or rupture of the cord very close to the abdomen. When signs of infection are diagnosed, cauterization is not indicated, but local hygiene with antiseptics less harmful to tissues is, due to the risk of rupture of the urachus and formation of uroperitoneum. In these cases, broad-spectrum antibiotic therapy is indicated, with the intuition of controlling omphalitis and, thus, allowing the regression of the urachus. In simple cases of patent urachus, medical therapy is sufficient, but the accumulation of intra-abdominal or subcutaneous urine and uracal abscesses justify urgent surgical correction. The prognosis of persistent urachus is excellent in most cases, being considered good in animals that have acquired persistence with umbilical infection, as long as it is diagnosed early and with immediate medical and/or surgical care. It is not possible to prevent a foal with abnormal urachus from being born. However, it is possible to prevent the development of umbilical infection, with the resulting failure to close or reopen the urachus. For this, it is important: carefully monitor the foals' navel in the first weeks of life, make daily umbilical deeping with non-irritant antiseptics such as chlorhexidine or diluted iodine solution, make sure that the foal has received appropriate colostrum, dosing IgG, after 24 hours of life, which indicates that the foal has received adequate immunity, considering the value above 800mg / dL to be ideal, and if not, administer plasma or hyperimmune serum to confer immunity and prevent umbilical infection or any other infection body part.