2.1.2 Surgery
At surgery, a one stage umbilical vein marsupialization was performed due to a severely enlarged and friable umbilical vein that continued into the liver.8 The colt was placed in dorsal recumbency. A fusiform-shaped skin incision was made around the umbilicus and sharp dissection was used to enter the abdomen. The umbilical vein was transected as far cranial as possible without leading to contamination. The umbilical vein remnant was exteriorized through a secondary 6 cm incision to the right of midline. The vein marsupialization was sutured in place with simple interrupted sutures using 2-0 poliglecaprone 25 to the abdominal wall, subcutaneous tissue and skin. An abdominal lavage with sterile physiologic saline was performed prior to ventral midline incision closure. The incision was closed in a simple continuous pattern –2 USP polyglactin 910 for linea alba, 2-0 USP poliglecaprone 25 for subcutaneous layer, 2-0 USP poliglecaprone 25 for skin. An Ioban bandage was placed over the marsupialization and omphalectomy incisions for recovery.
Post-operatively the foal was continued on antibiotics and omeprazole for 6 days. Flunixin meglumine was continued for 3 days.
The umbilical vein was rinsed in dilute chlorhexidine solution twice daily during hospitalization. The foal was discharged alive after 6 days of hospitalization on trimethoprim sulfamethoxazole (30 mg/kg, orally, q 12 hours) for 7 days and twice daily spraying of the marsupialization site with dilute chlorhexidine solution.