Gastric dilatation and volvulus is a surgical emergency that occurs typically in large and giant breed, deep-chested dogs. The primary clinical signs are non-productive retching, restlessness and abdominal pain. The exact cause is unknown. The stomach is dilated with gas and rotates on its axis, usually 180 degrees. This rotation or volvulus prevents inflow and outflow of ingesta from the stomach. More importantly, it interrupts normal blood flow to the stomach and can lead to death of varying portions of the stomach wall if left untreated. The spleen is located next to the stomach and may be involved in the rotation as well, interrupting splenic blood supply with the same sequela.
Unfortunately, damage may not be limited to these two organs. In some instances where the stomach is very dilated/large, blood returning from the lower half of the body to the heart may be impeded. This prevents the heart from pumping adequate amounts of blood around the body and multiple organs/systems can thus be affected (hypovolemic shock). These changes generally come in the later stages of a GDV and so early treatment is always indicated.
Treatment of a gastric dilatation and volvulus is surgical, once the cardiovascular system has been stabilized. The stomach must be deflated and manually flipped back into its normal position. To help prevent recurrence of volvulus, the stomach is then permanently attached (pexied) to the body wall. It is important to remember that dilatation with out volvulus can still recur and break down of the pexy site with resultant rotation, however uncommon, is still possible.
The major complication of surgery is extensive death of the stomach wall. Only a certain amount of stomach wall can be removed. The entire spleen can be removed if need be. Certainly patients that are less cardiovascularly stable are at a higher risk for anesthetic complications. Anytime there is disruption of the normal gastrointestinal wall barrier to bacteria with in the GI tract, there is concern for sepsis (bacteria or their toxins entering circulation). Heart arrhythmias are common in these patients. Usually they are benign, but occasionally cause problems with blood out put from the heart. Most of the time they can be controlled with drug therapy.
Post-operative monitoring and treatment involve continued IV fluid administration with or without electrolyte supplementation; continuous EKG monitoring with possible treatment of arrhythmias; broad-spectrum antibiotic therapy; medications to reduce nausea, stomach acidity and vomiting; incisional care as needed; pain management. Generally, the patient is not offered anything by mouth for at least 12 hours. Water is first offered in small amounts and eventually very small amounts of food at around 24 hours. If no vomiting results, the amounts are gradually increased. Once the patient is drinking and eating enough to support itself (with out vomiting), mobile, showing no signs of sepsis and relatively comfortable, he/she is sent home for the remainder of recovery.