Uroperitoneum in cattle: Ultrasonographic findings, diagnosis and treatment
© Braun and Nuss. 2015
Received: 14 April 2015
Accepted: 22 June 2015
Published: 3 July 2015
This review describes causes, clinical signs, metabolic changes in serum and peritoneal fluid, diagnosis and treatment of uroperitoneum. Rupture of the bladder or urachus is the most common cause of uroperitoneum. The main clinical sign is a pear-shaped enlargement of the abdomen accompanied by gradual deterioration in demeanour and appetite. Ultrasonography shows massive accumulation of anechoic abdominal fluid and organs suspended in the fluid. Bladder defects may be seen cystoscopically and the proximal part of a persistent urachus can be explored endoscopically. Abdominocentesis yields light yellow fluid. A peritoneal-to-serum creatinine concentration ratio of 2 or greater is diagnostic of uroperitoneum. Treatment consists of surgical repair of the defect.
KeywordsCattle Ascites Uroperitoneum Bladder rupture Persistent urachus Ultrasonography
Uroperitoneum is accumulation of urine in the peritoneal cavity caused by leakage of urine from the kidneys, ureters, urinary bladder or urethra  or from a ruptured persistent urachus [2, 3]. Renal trauma caused by blunt force, entrapment, falls, puncture or accidental trocarisation  may rupture the renal capsule leading to leakage of urine into the perirenal tissues. Leakage of urine from a kidney may also occur with hydronephrosis caused by a ureteral obstruction. Retroperitoneal accumulation of urine referred to as urinoma is usually the result of leakage from a traumatised ureter . In male cattle, rupture of the urethra usually leads to subcutaneous urine accumulation with pitting oedema along the ventral abdominal wall (waterbelly) and in the inguinal region . Rupture of the bladder and urachus are the predominant causes of uroperitoneum in female cattle [2, 3]. The goal of this review is to describe the causes, clinical signs, diagnosis and treatment of uroperitoneum in cattle.
Preparation of the review
The databases PubMed and VetMed Resource for the years 1975 to January 2015 were searched in January 2015 for the keywords cattle, cow, calf, uroperitoneum, bladder, urachus, urachal rupture, bladder rupture, ultrasonography. In addition, the list of references of standard texts (references 1, 4 and 5) were scrutinised for relevant articles. All publications related to the topic of this review were included. There were no publication restrictions.
Uroperitoneum caused by bladder rupture
In male cattle, bladder rupture is usually secondary to obstruction of urinary outflow , the most common cause of which is urolith-induced urethral obstruction . Urethral strictures caused by injury, necrotising inflammation, surgical procedures such as urethrotomy or castration  or urethral compression by a tumour, abscess or haematoma are rare causes of urinary outflow obstruction and bladder rupture [4, 6]. One case report described urethral obstruction, urinary outflow obstruction and eventual bladder rupture due to haematoma formation in the urethral submucosa in a three-month-old bull calf . In another report, a haematoma associated with a comminuted fracture of the first two coccygeal vertebrae led to urethral compression and subsequent bladder rupture in a 16-month-old Limousin bull . Bladder rupture in a four-month-old bull was thought to be caused by infection of the umbilical artery in the neonatal period, which led to necrosis and inflammation of the bladder wall and creation of a diverticulum .
Uroperitoneum caused by urachal rupture
Immediately after umbilical cord rupture, the urachus retracts into the abdominal cavity toward the apex of the bladder, and its peritoneal covering gives rise to the vesicoumbilical ligament. The distinct conical vestige of the urachus at the apex of the bladder is referred to as urachal umbilicus in the German veterinary literature . Urachal anomalies result from partial or complete failure of urachal involution, which has been described extensively in humans . Failure of complete urachal obliteration results in a persistent urachus, which is accompanied by urine dribbling from the urachus during or after urination. A partially patent urachus may persist as a bladder diverticulum, which is patent toward the bladder but obliterated toward the umbilicus. A subcutaneous urachal diverticulum can also occur in calves with a defect in the linea alba and a persistent urachus that is patent from the bladder to the umbilicus . An umbilical fistula occurs when the urachus is obliterated toward the bladder but remains patent toward the umbilicus. A urachal cyst may arise when the middle section of the urachus remains patent and both ends obliterate . Reports of anomalies of the urachus and bladder reflect the wide spectrum of changes associated with abnormal urachal involution.
Urachal anomalies in cattle with ruptured urachus
Baxter et al. 
Bell et al. 
Braun et al. 
BV x BS
BV x BS
BV x BS
BV x BS
BV x BS
Braun et al. 
BV x BS
Braun, not published
BV x BS
Edwards et al. 
Charolais x Brangus
Hylton and Trent 
Marques et al. 
5 bulls of different breeds
5 – 7 years
Nikahval and Khafi 
Clinical signs of uroperitoneum
Metabolic changes associated with uroperitoneum
Haematological and serum biochemical findings in cattle with uroperitoneum
Results of haematological analysis in 8 cows with uroperitoneum
Variable (reference interval)
Urea (2.7-5.7 mmol/l)
Creatinine (88–133 μmol/l)
Haematocrit (25–37 %)
Total leukocyte count (3.9-9.1 x 103/μl)
Potassium (3.8-5.3 mmol/l)
Sodium (143–157 mmol/l)
Chloride (98–109 mmo/l)
Urinary findings in cattle with urachal or bladder rupture
Although urination may be absent, urine can be collected by catheterisation in most cows with urachal or bladder rupture because the bladder is not completely empty. In a study of five cows with urachal/bladder rupture, urine could be collected with a catheter in all but one . In that study, the urine was grossly normal in three cows, and a urine test strip showed haematuria in two cows . Uroperitoneum is accompanied by isosthenuria indicating that large amounts of urine are produced in an attempt at eliminating waste from the blood.
The entire abdomen is examined ultrasonographically from both sides. In addition, transrectal ultrasonographic examination is carried out and the penile urethra is scanned for concrement in male animals. The examination is done in the standing non-sedated animal, but calves can also be examined in a lying position. The skin is clipped and cleaned with alcohol and conductive gel is applied. Linear or convex transducers with a frequency of 3.5 or 5 MHz are best suited but abnormalities close to the skin also can be assessed with a 7.5-MHz transducer. The abdomen is first examined on the right side from caudal to cranial. The transducer is placed at the paralumbar fossa and then moved ventrally to the midline. This is repeated in a cranial direction toward the last rib and then the last two intercostal spaces are examined in a similar fashion. The examination is repeated on the left side in an analogous manner. The bladder and urethra are scanned transrectally with the transducer directed ventrally and the caudal part of the left kidney is examined with the transducer directed dorsally. In male animals, the penile urethra is examined between the scrotum and prepuce . The abdominal organs normally occupy the entire abdominal cavity and are separated from each other and the peritoneum by capillary spaces, which contain very small amounts of serous fluid to lubricate the surface of tissues. The capillary spaces are not normally visible ultrasonographically but can be imaged when they enlarge as a result of fluid accumulation or other disease processes. Likewise, the omentum and mesentery are difficult to visualise ultrasonographically in healthy ruminants but are easily seen when separated by fluid. The high fat content of these structures increases sound reflection. The organ contours usually are smooth and echoic deposits with or without fluid inclusions are considered abnormal. The fluid between organs is assessed for amount and echogenicity; the latter can range from anechoic to echoic and may appear homogeneous or heterogeneous. If the fluid is an exudate, echoic inflammatory sediment may be seen at the lowest point accompanied by a hypoechoic supernatant. Strands of fibrin often can be seen running in a spider web-like fashion between organs or between an organ and the parietal peritoneum.
Abdominocentesis in cattle with uroperitoneum
Bladder rupture caused by dystocia has a poor prognosis because the bladder wall often is severely contused and compromised . In contrast, the bladder musculature and mucosa are not or only minimally affected with urachal rupture and therefore uroperitoneum caused by urachal rupture usually has a favourable prognosis .
Surgical treatment of uroperitoneum
A ruptured urachus usually is not completely detached but can be identified as a tissue strand between the pole of the bladder and the internal umbilical ring. The urachus can be broken manually at its attachment to the umbilicus or it may be cut close to the umbilicus using blunt/blunt scissors. Cutting with scissors is safe because adjacent organs and the omentum are suspended in urine and thus lifted off the ventral abdominal wall. The remaining urine is evacuated and the abdominal cavity rinsed with isotonic saline solution. The free end of the urachus and the bladder usually can be pulled into the incision and examined for ruptures . Persistent urachus is associated with elongation of the bladder, which aids in exteriorisation of the bladder. The bladder is retracted with the aid of stay sutures or clamps and the pole of the bladder with the attached urachus is resected. The bladder is closed in two layers, a continuous suture oversewn by an inverting suture [33, 34] or two inverting sutures . The abdominal wall is closed after lavage of the muscle layers to reduce the risk of contamination.
The method of treatment of bladder rupture depends of the location of the wall defect. Dorsal tears may heal spontaneously if a Foley catheter is placed transcutaneously or through the urethra to drain the urine . Ventral tears usually require surgery via caudal flank or ventral midline coeliotomy using local or general anaesthesia. Bladder distension using saline solution aids in localising the wall defect and in ensuring secure closure after surgery. Bladder surgery is difficult in large cows because exteriorisation of the bladder and visualisation of the defect can be a problem and much of the suturing may have to be done blindly. Alternatively, laparoscopic or laparoscopic-assisted surgical techniques may be used to close the bladder defect . The suturing technique is analogous to that described for urachal tears . If an uroperitoneum is caused by leakage of urine from an ureter or a kidney, unilateral nephrectomy may be performed.
Postoperative treatment includes procaine penicillin or amoxicillin for 5 to 7 days and a nonsteroidal antiinflammatory drug such as flunixin meglumine for 3 days. Intravenous fluid therapy consisting of daily infusion of 10 l of a NaCl-glucose solution (50 g glucose and 9 g sodium chloride/l) for 3 to 5 days is recommended.
Diagnosis of uroperitoneum is not always straightforward because other diseases that result in accumulation of intraabdominal fluid must be ruled out. In most cases, uroperitoneum can be diagnosed based on the results of ultrasonography and abdominocentesis and calculation of the peritoneal-to-serum creatinine concentration ratio. The cause of uroperitoneum often can be determined and the condition corrected surgically.
The authors thank Ms Sonja Warislohner for the video recordings.
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