Gastric dilatation volvulus (GDV), also known as twisting stomach syndrome in dogs, can pose severe health concerns that require emergency veterinary surgery to correct. Without treatment quickly enough, blood flow to the stomach would cease entirely, impairing breathing and potentially harming other organs. Emergency surgery untwists the stomach, relieves pressure and may include extracting dead tissue removal as well as performing gastropexy to affix it to the abdomen wall – essential measures against further complications in later life.
1. Preparation for Surgery
Stabilizing measures include shock rate fluids, gastric decompression and placement of a gastropexy tube with bandaging over it to protect and prevent vomiting. Fluid therapy should continue at 8-10 ml/kg/hr with balanced electrolyte solution while ECG and pulse and blood pressure measurements should also be performed regularly; analgesics should also be given on an as-needed basis in order to alleviate pain or discomfort, while antiemetics (metoclopramide 0.2-0.5 mg/kg IV every 6-8 hours or maropitant 1 mg/kg IV every 6-8 hours respectively) may prove useful depending on each patient.
Following surgical exploration, the surgeon can often ascertain the viability of both spleen and stomach wall structures. If either are severely compromised, full-thickness resection should be performed; in case of irreversible vascular compromise affecting either organ, splenectomy may be recommended to lessen release of toxic substances or thromboemboli into systemic circulation.
In cases of clockwise volvulus, applying downward pressure on the right side of visible stomach along with traction to pylorus can help facilitate counterclockwise rotation. Care should be taken to identify any areas of nonviable tissue at the junction between fundus and body of stomach. When in more normal positions, surgeons should inspect for active sites of hemorrhage and ligate any that they find. The spleen should be evaluated for signs of ischemia, such as dull or cyanotic appearances. A splenectomy may be required in cases of extensive involvement; closure should follow an interrupted pattern using either polydioxanone or polyglactin 910 (Vicryl-Ethicon) suture material, or surgical stapling device.
2. Preparation for the Operation
Patients suspected of gastric torsion must be immediately resuscitated and medically optimized before surgical correction can take place. Fluids should be administered at an 8-10 ml/kg/hour rate while electrolyte balance must also be preserved. Systemic opioid analgesics will help minimize postoperative discomfort; pulse rate, blood pressure and urine output should also be periodically assessed.
An open cranial ventral midline laparotomy should be performed, incision being made caudal to the last rib and ventral to the transverse vertebral process on the right stomach wall caudal of last rib and ventral of transverse vertebral process aseptically prepared; percussion should indicate decompression (tympany); otherwise an orogastric tube can be placed under intraoperative guidance by nonsterile assistant, using either halothane or isoflurane for temporary decompression (decompression).
Manual attempts at manually rotating the stomach with counterclockwise traction and downward force on the pylorus may help restore rotational position. A thorough assessment is then conducted, including removal of any areas of ischemic gastric wall or splenic thrombosis that have occurred, closure using either continuous or interrupted sutures in submucosa/muscularis and simple Cushing or Lembert closure in serosa using polyglactin 910, polydioxanone, or polyglycolic acid suture materials recommended.
3. Post-Operative Care
Gastric dilatation and volvulus (GDV) is a serious emergency for any dog, but rapid action from a veterinarian could mean the difference between survival and death of this condition. GDV is a time-sensitive condition requiring rapid recognition and surgical intervention. Once aseptic prep has been completed, a cranial ventral midline laparotomy must be performed in order to access and expose the twist in the stomach. Once the stomach has been decompressed and manipulated, an orogastric tube can be placed by either a non-sterile assistant operating under intraoperative guidance of the surgeon or by needle gastrocentesis for distended, tightly twisted stomachs. Fluid therapy and analgesics will then be provided, along with close monitoring of PCV, TP, total solid concentrations, electrolyte concentrations, blood glucose and lactate concentrations.
