Gastric dilatation volvulus (GDV) is a life-threatening condition caused by excessive gas accumulation, with stomach distension then twisting 180 to 360 degrees around its short axis (or “volvulus”). Without prompt surgical intervention it can result in shock and even lead to death. [1]
Stabilizing a patient requires decompressing the stomach using either orogastric tubes or percutaneous gastrocentesis.
Treatment
Gastric dilatation-volvulus syndrome, more commonly referred to as “bloat,” is an emergency condition whereby an animal’s stomach becomes enlarged by excessive gas accumulation (dilation) and then twists around its short axis (volvulus). When this happens, the stomach can block the esophagus, preventing belching or vomiting as a means of expelling excess gasses; symptoms include bloating, abdominal discomfort and respiratory distress resulting in inflamed and ulcerated esophagus pressure from being forced upstream as well as possibly inflamed and ulcerated from pressure caused by being forced through by its short axis; additionally the intestines and liver may be affected as a result of this emergency condition.
Step one in treating trapped gas is to release it by inserting a tube down your throat. Unfortunately, this can often be difficult in cases of volvulus; usually only after X-rays have been taken to confirm dilated stomach and rotated spleen (see image of X-ray).
Once the gas has been eliminated through a nasogastric tube, it is crucial to stabilize the patient. This can be accomplished by decompressing the stomach using orogastric intubation or trocharization; decompression relieves pressure on caudal abdominal vena cava and allows blood from caudal body parts back toward heart (resulting in improved preload).
As part of routine examination, it is necessary to evaluate both the stomach and spleen for signs of ischemia. If necessary, severe damage must be corrected in order to reduce hepatotoxicity, then stomach should be returned back into its usual position and gastropexy performed to lower risk of recurrence.
A gastropexy entails using two rows of long-lasting absorbable monofilament sutures – typically grade 2-0 monofilament suture material – starting from the cranioventral midline incision to seal off both gastroesophageal divisum valves (GDVs). A right-sided gastropexy is performed to help avoid volvulus recurrence; all patients at risk should undergo one at some point as this will minimize future issues.
Diagnosis
GDV occurs when a dog’s stomach fills with air, fluid or food and twists itself around within its abdomen, creating an emergency medical situation requiring immediate veterinary care and intervention – otherwise it can become fatal within minutes if left untreated.
X-rays and abdominal ultrasound are effective ways of diagnosing twisted stomachs in dogs. Because the symptoms can often resemble those of bloat, it’s crucial that your dog be examined by a veterinarian with in-house diagnostic capabilities so they can distinguish between the two conditions. Sedating your pet and passing a tube into their stomach to release pressure are effective solutions; however, if their stomach is twisted (determined via an x-ray scan), passing this tube could result in serious injury to their pet and could even risk life-threatening injuries!
Treatment for a twisted stomach typically requires rapid surgical intervention. At first, the stomach must be decompressed using either an endoscope placed through the mouth or trocars placed through its wall to release any pressure build-up. Once decompressed, surgeons can return it to its original position before inspecting for areas of ischemic stomach wall that require partial gastric resection or splenectomy; alternatively they may perform gastropexy as part of gastropexy which will create permanent attachment between pyloric antrum and right stomach wall to decrease risk and reduce recurrence risk.
Postoperatively, intravenous fluid therapy for volume resuscitation should continue postoperatively; this may involve isotonic and hypertonic solutions as well as colloids like hetastarch; in addition, antibiotics are often administered post-op to prevent infection recurrence rates are approximately 75% for gastropexy.
Surgery
Gastric dilatation-volvulus syndrome, more commonly referred to as “bloat or twisted stomach”, occurs when an animal’s stomach fills with excess gas or fluid and rotates clockwise (volvulus). GDV is life-threatening, necessitating emergency surgery; with prompt treatment the survival rate can range anywhere between 10-60 percent.
As a first step toward treating GDV, decompression should be performed using either gastrocentesis or by passing a stomach tube through. This will allow the surgeon to properly evaluate abdominal viscera for signs of necrosis and confirm correct torso positioning. Once decompressed sufficiently, surgeons can reposition the stomach by pushing its fundus dorsally while pulling its pylorus ventrally toward the right side of the abdomen.
Once the stomach has been repositioned, a surgeon will conduct a full abdominal exploration, which includes palpation of the splenic mesentery which usually displays dark purple colors due to engorgement. When necessary a splenectomy may be performed; particularly where evidence exists of thrombosis or hemorrhage. Also present may be bleeding from short gastric arteries which must be controlled using ligatures.
Following surgery, patients should receive intravenous fluid therapy and pure mu agonist analgesia for pain management. Arrhythmias that typically arise from the ventricle should also be closely monitored with continuous ECG monitoring to detect cardiac dysfunction. Patients receiving antibiotics should be transferred to a 24-hour care facility for 24-hour monitoring; fluid resuscitation should also take place to address electrolyte imbalances while providing sufficient blood flow to the stomach to avoid peritonitis.
Food should not be given until after the surgical site has fully healed – typically 48 hours postoperatively – though nasogastric feeding tubes may be placed to provide small meals of a gastrointestinal diet in between these periods. Antiemetics like metoclopramide or maropitant should be prescribed if vomiting persists.
