Gastric Dilatation and Volvulus (GDV, or “twisted stomach”) occurs when a dog’s stomach becomes filled with gas, fluid or food and rotates until it presses on large blood vessels to reduce circulation of blood to the stomach wall. It is especially dangerous among deep-chested breeds. Early warning signs include unproductive retching or an unusually distended and tight drum-like abdomen that could indicate GDV is present.
Causes
The stomach is a muscular organ suspended by ligaments and tendons, allowing it to expand but also making it vulnerable to torsion. Over time, these tendons and ligaments become less firm, increasing its likelihood of rotation with gravity – particularly among giant breeds like Great Danes. Feeding habits, genetics and exercise directly after meal times all increase risk factors for Great Dane vomiting (GDV). Large meals taken regularly at fixed times along with exercise immediately post meal can all increase distension of stomach distension or torsion of torsion of GDV risk.
GDV occurs when a dog’s stomach becomes distended with gas (dilation) and twists (volvulus). From the front view, its appearance resembles that of a drum-like structure. Volvulus traps gas and prevents its expulsion through the pylorus into the intestines, creating pressure which causes systemic shock, multiple organ dysfunction, restricted breathing ability as well as oxygen delivery to tissues reducing oxygen delivery leading to necrosis (tissue death).
GDV symptoms in dogs include non-productive retching, rapid heart rate, labored breathing and rigid abdomen. At its final stages of torsion, an x-ray may show a double bubble pattern which indicates that the pylorus has moved to opposite side of stomach which prevents belching or vomiting to release gasses from being effective releases of pressure in releasing accumulated gases.
GDV can often prove fatal without prompt treatment, making early recognition and planning key components to protecting your pet from this condition. You should recognize warning signs early and establish an emergency veterinarian visit plan as soon as possible for high-risk dogs; feeding practices, stress management and preventive gastropexy are your best defenses against GDV – one of veterinary medicine’s most serious emergencies, yet highly treatable when recognized and addressed quickly; key indicators include inability to eat, bloat/distension of abdomen/retching without results/weakness/labored breathing/high heart rates among others. Never underestimate these indicators!
Diagnosis
Diagnostic criteria for twisted stomach can typically include taking a right lateral radiograph of the abdomen and palpating for tight, drum-like sensation in the stomach. Patients suffering from this condition will usually exhibit signs of stress by pacing or whining frequently, and have an unusually distended abdomen in a “reverse C” shape due to rotation around the gastrosplenic ligament.
Other indicators of GDV may include unproductive retching and drooling as well as adopting an assumed prayer position with front legs down and rear end up. Untreated patients of GDV can quickly deteriorate into death; prompt treatment should therefore be sought immediately to mitigate damage and save lives.
Torsion and volvulus of the colon are more frequent than stomach torsions and more difficult to diagnose, though both terms may be used interchangeably by many healthcare practitioners. Torsion refers to twisting around its long axis while volvulus means twisting around its mesenteric axis – both can result in mechanical obstruction and ischemia.
Abdominal pain is one of the primary reasons for pets being admitted to veterinary hospitals, with four main pathologic processes contributing: ischemia, inflammation, distention and traction being primary culprits. Organ torsions may occur alongside all four processes but tend to be most severe in terms of severity.
Diagnosing splenic torsion can be challenging due to its diffuse appearance and inability to show blood flow on color Doppler ultrasound (Figure 5). One reliable sign of splenic torsion is a hyperechoic triangle around the vascular pedicle which appears as an upside-down “C” (FIGURE 6).
Before performing any surgical interventions on the stomach, it is crucial to first verify its position by palpating its stomach, esophageal sphincter and phrenicosplenic ligament. Confirmation is also vital because an unintended counterclockwise rotation could cause splenic volvulus with hemorrhage through short gastric arteries and veins; should any hemorrhage persist after it has been repositioned this should be ligated to avoid further complications.
Treatment
GDV (or “twisted stomach”) is a potentially life-threatening condition involving an overstretched and rotated stomach that occurs most frequently in large, deep-chested dogs; eating large meals quickly, exercise immediately after eating, stress, and unproductive retching are the hallmarks of GDV; other symptoms include visibly distended abdomen that feels tightened up like a drum and signs of distress such as whining, pacing, taking prayer position with front legs down/rear end up and collapse.
Cause: Hypovolemic shock results when a compartment forms within a dilated stomach that restricts both gastric entry and exit points and traps stomach contents. Compression forces gastric arteries to stretch, inhibiting their proper blood flow resulting in serosal hemorrhage, oedema and serosal hemorrhage which eventually causes intraabdominal pressure increases as low-pressure vessels such as caudal vena cava and splanchnic and portal veins being compressed further restricting their blood supply resulting in hypovolemic shock.
Fluid resuscitation should be the initial step in treatment, and should continue after stabilization is achieved in order to avoid hypovolemic shock. Common therapies include intravenous (IV) isotonic crystalloids and colloids such as hydroxyethyl starch (10-30 mL/kg/day), fresh frozen plasma or other blood products as necessary; gastroprotectants like sucralfate and histamine-2 receptor antagonists may be given due to an increased likelihood of gastric ulcers in this patient group; while for pain management, an opioid pure mu agonist should be the preferred medication option.
Once repositioning has been achieved, decompression must take place by passing an orogastric tube through the abdominal wall to drain gas from the stomach and decompress the abdomen. Once decompressed, palpating should be performed for areas of ischemia or thrombosis and necrotic tissue must be removed as necrosis occurs; necrosectomy techniques include incisional, belt-loop, and tube gastropexy.
During surgery, the stomach is drained, and right-sided gastropexy is performed to lower risk of recurrence. Careful palpation of abdominal viscera allows for accurate diagnosis and rapid responses when dealing with patients in shock.
