Gastric torsion, commonly referred to as twisted stomach in dogs, is a potentially life-threatening condition. It occurs when gastric fluid or food accumulates to dangerously large quantities within their stomach, then twists around its long axis (Volvulus).
Start stabilization process by decompressing distended stomach. This can be accomplished using orogastric intubation or trocharization at area of greatest gastric tympany – usually found over right abdominal wall caudal to last rib.
Preventing Volvulus
Gastric dilatation-volvulus, commonly referred to as “twisted stomach,” is a potentially life-threatening condition where your pet’s stomach fills with gas, fluid or food and expands, becoming distended as it twists on itself to form a knot. This twisting can then press on large blood vessels obstructing blood flow causing shock while simultaneously impacting on spleen and stomach functions causing further complications.
GDV, or gastric dilatation and volvulus, is a progressive disorder that can prove fatal if left untreated. At its initial stage, an enlarged stomach may simply be known as “bloat,” while over time this may progress to volvulus, in which an enormous gas-filled sac rotates so rapidly that both its entrance and exit become blocked; this requires immediate surgery as a medical emergency.
GDV is often found in deep-chested breeds of dog such as Great Danes, German shepherds, standard poodles, basset hounds and weimaraners; however any breed can become susceptible to this life-threatening condition.
GDV typically manifests with acute abdominal or lower thoracic pain that rapidly escalates to vomiting, retching, and difficulty passing a nasogastric tube past the gastroesophageal junction (GEJ). Roentgenography typically shows an “upside-down” stomach with rotation around its short axis and herniation of the GEJ into chest cavity.
Emergency treatment for GDV should aim to restore circulating blood volume, provide pain relief, and rapidly surgically correct volvulus. One effective means of preventing future episodes is gastropexy; this procedure attaches the stomach directly to abdominal wall so it cannot twist upon itself; gastropexy has proven extremely successful at decreasing GDV recurrence for both predisposed and non-predisposed dogs alike.
Diagnosing Volvulus
GDV, also known as gastric dilatation volvulus or “twisted stomach”, is a serious medical condition in dogs. It occurs when their stomach fills with gas, food or fluid and then twists so that its entrance and exit points become blocked, often leading to fatal consequences if left untreated. Signs of GDV include an enlarged abdomen; non-productive retching; inability to lie down; restlessness, pacing, salivation and pale gums.
GDV can usually be detected with a right lateral abdominal radiograph, which shows two distinct abdominal bubbles separated by soft tissues bands or “popeye arms”, between the pylorus and fundus of the stomach. Furthermore, an enlarged spleen may entrap itself within these double bubbles leading to reduced perfusion to various organs including digestive system, cardiovascular system, liver, and kidneys.
An ultrasound of the spleen can reveal a round, distended structure with a central venous sac (see image below). Due to compression of the caudal vena cava, blood in this area cannot return to the heart in time leading to rapid decreases in blood pressure and shock.
GDV causes dogs to become hypovolemic, which can result in various complications including organ dysfunction. Lung function is especially compromised because distended stomach reduces blood flow to them resulting in decreased lung volume and respiratory distress; further compounded by attempts at vomiting which increase abdominal air volume thus increasing aspiration pneumonia risk.
GDV should always be treated as an emergency by veterinarians, with immediate medical intervention to stabilize, decompress and evaluate organs for signs of ischemic damage as soon as possible (gastropexy). GDV occurs more commonly among large deep-chested breeds; young dogs and those at lower-risk may require less risky surgery procedures for gastropexy than their elders due to reduced risks involved with surgery and when performed prophylactically prevent GDV altogether.
Treatment of Volvulus
Gastric dilatation-volvulus, or GDV, is an emergency medical condition in which your pet’s stomach becomes distended with food, air or fluid and twists on itself, becoming distend and eventually fatal if not addressed quickly and surgical intervention should always be sought immediately.
GDV can be difficult to diagnose due to dramatic abdominal changes; however, using a symptom checklist may help you make an informed decision as soon as possible regarding whether your pet needs immediate veterinary attention. A typical checklist will ask questions regarding symptoms displayed by your dog as well as for how long he or she has displayed these characteristics.
Volvulus is usually caused by diaphragmatic defects that result in involuntary stomach rotation. The stomach can spin either around its mesenteroaxial axis, running along its center between lesser and greater curvatures of stomach, or around an organoaxial axis running between gastroesophageal junction (GEJ) and pylorus; combinations between both axes are also possible; full rotation can severely impair gastric blood flow leading to gangrene while partial can only cause minor obstruction;
Supine radiographs of the stomach reveal an intrathoracic, gas-filled viscus in cases of mesenteroaxial volvulus; while upright radiographs reveal one air-fluid level in an abnormally transversely oriented stomach in organoaxial volvulus; both forms occur below the antrum.
At first, GDV can lead to obstruction of gastric outflow and compromise venous return from the splenic to the gastrointestinal tract, potentially leading to hypovolemic shock. When stomach distention progresses further, intragastric pressure rises and compresses both splenic and renal vena cavae further impeding on venous return.
Fluid resuscitation and gastric decompression via nasogastric or orogastric tubes are crucial elements in treating GDV. Surgery aims to reduce volvulus by performing gastropexy, which restores normal anatomy in the stomach. Furthermore, any intraabdominal factors predisposing to future episodes of GDV will also be repaired by surgeons at this time. Unfortunately GDV remains fatal, although survival rates are improving thanks to advances in veterinary medicine and swift treatments.
Post-Surgical Care
Gastric torsion is a life-threatening condition. Early diagnosis and treatment increases survival rates. Patients suffering from gastric torsion have an increased risk of gastric strangulation complication which has mortality rates exceeding 30%. An interprofessional team including radiologists, emergency department physicians, general surgeons and gastroenterologists should perform proper diagnosis.
When keeping patients upright and using a nasogastric tube to decompress the stomach (drainage), this allows blood from caudal body parts to move back toward the heart, improving preload and gastric perfusion. Pushing past the lower esophageal sphincter may result in perforation of this organ. Percutaneous gastrocentesis may also be performed to release gastric fluids. For this procedure, clipping and aseptically prepping an area over right abdominal wall caudal to last rib, followed by passing large-bore needle or over-the-needle catheter into stomach at site of greatest tympany.
At the conclusion of a comprehensive abdominal exploration, it is imperative to assess the viability of stomach wall, spleen and any other organs involved in volvulus. If the spleen has black spots or has developed thrombosis it must be surgically removed; once this has occurred the stomach should be returned to its regular position in the abdomen and surgically fastened onto its host wall (gastropexy) to prevent future rotation of its contents and reduce morbidity and mortality rates.
After surgery, patients require intensive care to monitor heart rhythms, electrolytes and blood glucose levels. Intravenous fluid therapy, antibiotics and analgesia should be given for at least 24 hours post-op to keep hydration optimal and to alleviate pain after GDV has occurred. A nasogastric tube should be placed to allow feeding but bland or gastrointestinal diet should be used as well. Antiemetics like Metoclopramide or Cisapride may be given to help prevent vomiting due to gastric ulceration or perforation; antiemetics should help prevent vomiting caused by GDV resulting from ulceration/perforation resulting from gastric ulceration/perforation resulting from GDV; those exhibiting persistent vomiting/ abdominal pain/ signs of shock should be transferred immediately to specialized 24-hour facility as these individuals may be at increased risk of complications associated with GDV including peritonitis/DIC complications related to complications caused by GDV.
