Gastric dilation-volvulus

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Abdominal radiograph of a german Shepherd with GDV, showing gas distension of stomach[1]
Distended stomach and liver in a dog which died from GDV[2]
Appearance of a gastroplexy in a dog[3]

Gastric dilation-volvulus (GDV) is a life-threatening condition of deep-chested large and giant breed dogs where the stomach dilates and rotates on itself, leading progressively to hypotension, shock, and death.

Although numerous mechanisms have been proposed, the etiology of the disorder remains obscure[4], although feeding from raised bowls and exercise after consuming a large meal is commonly reported. Splenic torsion has also been implicated as a cause since malposition of the spleen is commonly observed with GDV as well as gastric foreign bodies[5], drugs which inhibit gastric motility, abdominal trauma, spinal injuries or prolonged recumbency. Diets containing high levels of fish and egg dietary supplements[6], or containing soy, wheat corn or rice may also be factors. Splenectomy does not appear to increase the risk of GDV in dogs[7].

Large (Akita, Bloodhound, Collie, Irish Setter, Rottweiler, Standard Poodle, Weimaraner, Huntaway[8], Grand Bleu de Gascogne, German longhaired pointer, Neapolitan Mastiff[9]) and giant breed (Great Dane, Irish Wolfhound, Newfoundland, Saint Bernard) dogs have a 6% incidence of GDV, with GDV accounting for 16% of all the deaths in these breeds[10]. In small breed dogs, the Dachshund appears to be over-represented.

Some dogs seem to inherit a predisposition for GDV, as there is an increased likelihood of GDV if a first-order relative (parent or sibling) has had GDV[11][12][13].

Recurrence and death in dogs treated medically for GDV are reported as being between 70 - 80%[14][15].

Gastric torsion-volvulus results in acute gastric ischemia and necrosis, predisposing to perforation and peritonitis[16].

Distension due to volvulus leads to compression of the caudal vena cava, resulting in consequential decrease in venous return and reduced cardiac output, resulting in many cases to noncardiogenic shock. As a consequence of gastric mucosal damage, absorption of bacteria and endotoxins leads to aggravation of circulatory compromise and septic shock. Avulsion of the short gastric and right gastroepiploic vessels and splenic vein torsion may occur, causing thromboembolism, hemorrhage and/or disseminated intravascular coagulation.

Clinically affected dogs present in acute collapse, with a visibly distended abdomen. The ability to pass an orogastric tube does not rule out GDV. Some cases can be due to chronic gastric instability and presumed incomplete volvulus, which may present as weight loss, chronic vomiting, lethargy and abdominal pain[17].

Abdominal radiographs are usually diagnostic and ECGs usually show ventricular arrhythmias and sinus tachycardia. The presence of preoperative cardiac arrhythmias is associated with a higher mortality rate[18].

Treatment requires aggressive intravenous fluid therapy (usually with lactated Ringer's solution or and colloid fluids[19]) and gastric decompression. Gastrocentesis should be performed in patients at risk from cardiac arrest or are too sick to approach surgically. Early treatment with intravenous lidocaine bolus (2mg/kg), followed by constant rate infusion of lidocaine for 24 hours post presentation decreases the occurrence of cardiac arrhythmias[20].

Once the dog is stabilized, surgical intervention is usually required. The basic goals of surgical treatment following decompression and derotation of the stomach is permanent fixation of the stomach in a manner that does not interfere with gastric function[21]. Currently, the most widely used gastropexy techniques are incisional gastropexy[22], belt-loop gastropexy[23], and circumcostal gastropexy[24]. Each of these techniques requires hand-suturing to produce a permanent adhesion of the stomach to the abdominal wall and do not require entrance into the gastric lumen.

A permanent incisional gastroplexy is the preferred treatment. Without gastropexy, a recurrence rate as high as 55% - 85% has been reported[25], compared with only 3% to 5% for dogs that did have a gastropexy[26].

Areas of stomach that are necrotic should be removed via gastrectomy. If there is a concern about pancreatitis, a jejunostomy tube should be placed for nutritional support.

With prompt treatment, survival approaches 85%[27].

Complications of surgery are not common but include hypokalemia, aspiration pneumonia, esophagitis, pulmonary edema[28], cardiac arrhythmias, gastroparesis, ileus and pancreatitis.

References

  1. Mom and Paw Shop
  2. Tufts University
  3. Belandria GA et al (2009) Gastropexy with an automatic stapling instrument for the treatment of gastric dilatation and volvulus in 20 dogs. Can Vet J 50(7):733-740
  4. Rivier P et al (2011) Combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation-volvulus. Can Vet J 52(1):62-66
  5. de Battisti A et al (2012) Gastric foreign body as a risk factor for gastric dilatation and volvulus in dogs. J Am Vet Med Assoc 241(9):1190-1193
  6. Pipan M et al (2012) An Internet-based survey of risk factors for surgical gastric dilatation-volvulus in dogs. J Am Vet Med Assoc 240(12):1456-1462
  7. Grange AM et al (2012) Evaluation of splenectomy as a risk factor for gastric dilatation-volvulus. J Am Vet Med Assoc 241(4):461-466
  8. Hendriks MM et al (2012) A retrospective study of gastric dilatation and gastric dilatation and volvulus in working farm dogs in New Zealand. N Z Vet J 60(3):165-170
  9. Evans KM & Adams VJ (2010) Mortality and morbidity due to gastric dilatation-volvulus syndrome in pedigree dogs in the UK. J Small Anim Pract 51(7):376-381
  10. Glickman LT et al (2000) Non-dietetary risk factors for gastric dilatation-volvulus in large and giant breed dogs. J Am Vet Med Assoc 217:1492–1499
  11. Glickman LT et al (1994) Analysis of risk factors for gastric dilatation and dilatation-volvulus in dogs. J Am Vet Med Assoc 204:1465–1471
  12. Glickman LT et al (1997) Multiple risk factors for the gastric dilatation-volvulus syndrome in dogs: A practitioner/owner case-control study. J Am Anim Hosp Assoc 33:197–204
  13. Glickman LT et al (1998) A prospective study of survival and recurrence following the acute gastric dilatation-volvulus syndrome in 136 dogs. J Am Anim Hosp Assoc 34:253–259
  14. Meyer-Lindenberg A et al (1993) Treatment of gastric dilatation-volvulus and a rapid method for prevention of relapse in dogs: 134 cases (1988–1991). J Am Vet Med Assoc 203:1303–1307
  15. Whitney WO (1989) Complications associated with the medical and surgical management of gastric dilatation-volvulus in the dog. Probl Vet Med 1:268–280
  16. Beer KA et al (2013) Evaluation of plasma lactate concentration and base excess at the time of hospital admission as predictors of gastric necrosis and outcome and correlation between those variables in dogs with gastric dilatation-volvulus: 78 cases (2004-2009). J Am Vet Med Assoc 242(1):54-58
  17. Paris JK et al (2011) Chronic gastric instability and presumed incomplete volvulus in dogs. J Small Anim Pract 52(12):651-655
  18. Mackenzie G et al (2010) A retrospective study of factors influencing survival following surgery for gastric dilatation-volvulus syndrome in 306 dogs. J Am Anim Hosp Assoc 46(2):97-102
  19. Haak CE et al (2012) Comparison of Hb-200 and 6% hetastarch 450/0.7 during initial fluid resuscitation of 20 dogs with gastric dilatation-volvulus. J Vet Emerg Crit Care (San Antonio) 22(2):201-310
  20. Bruchim Y et al (2012) Evaluation of lidocaine treatment on frequency of cardiac arrhythmias, acute kidney injury, and hospitalization time in dogs with gastric dilatation volvulus. J Vet Emerg Crit Care (San Antonio) 22(4):419-427
  21. Flanders JA & Harvey HJ (1984) Results of tube gastrostomy as treatment for gastric volvulus in the dog. J Am Vet Med Assoc 185:74–77
  22. MacCoy DM et al(1982) A gastropexy technique for permanent fixation of the pyloric antrum. J Am Anim Hosp Assoc 18:763–768
  23. Whitney WO et al (1989) Beltloop gastropexy: Technique and surgical results in 20 dogs. J Am Anim Hosp Assoc 25:75–83
  24. Leib MS et al (1985) Circumcostal gastropexy for preventing recurrence of gastric dilation-volvulus in the dog: An evaluation of 30 cases. J Am Vet Med Assoc 187:245–248
  25. Jonhson RG et al (1984) Gastric dilatation-volvulus: Recurrence rate following tube gastrostomy. J Am Anim Hosp Assoc 20:33–37
  26. Rassmussen L (2003) Stomach. In: Slatter D, editor. Textbook of Small Animal Surgery. 4th ed. Philadelphia: Saunders. pp.:592–640
  27. Beck JJ et al (2006) Risk factors associated with short-term outcome and development of perioperative complications in dogs undergoing surgery because of gastric dilatation-volvulus: 166 cases (1992–2003). J Am Vet Med Assoc 229:1934–1939
  28. Green JL et al (2012) Preoperative thoracic radiographic findings in dogs presenting for gastric dilatation-volvulus (2000-2010): 101 cases. J Vet Emerg Crit Care (San Antonio) 22(5):595-600