Gastric dilation-volvulus (GDV) syndrome is a painful and life-threatening condition in which the stomach becomes hugely distended with gas and fluid and rotates on its axis, often through 1800 to 3600. Gross gastric dilation can occur without rotation of the stomach.
Any breed of dog may be affected but large and giant breeds are predisposed – Great Danes, German Shepherds, Gordon and Irish Setters, Bassett Hounds, Airedales, Wolfhounds, Weimeraners and Rottweilers to name a few. A study found that 18% of all Great Dane deaths were due to GDV (Evans and Adams 2010). The specific cause is unknown but several risk factors beyond breed have been identified (Glickman 2000); a high ratio between chest height and chest width (deep-chested individuals), increasing age, having a first-degree relative affected, speed of eating, using an elevated food bowl. Other factors affecting incidence include male gender, low body weight, eating one meal per day and a fearful or anxious temperament.
Dogs may present following a period of restless behaviour, non-productive retching and hypersalivation. They will have a dramatic and progressing distension of their abdomen. They may be pale, with a rapid heart rate, breathing difficulties and may be collapsed.
Stretching of the stomach wall, and twisting, compromises the blood flow to the wall, reducing oxygen supply which can lead to death of the tissue. The spleen, which is attached to the stomach, can undergo twisting or torsion as well, leading to similar effects. The dilated stomach compresses the vena cava. Compression of this vein reduces the return of blood to the heart from the abdomen and hind legs of the dog. The dilated stomach presses on the diaphragm reducing its movement and consequently the ability for the lungs to expand normally. The circulatory and respiratory effects lead to a reduced supply of blood and oxygen to tissues, resulting in shock and if untreated eventually death.
Treatment includes aggressive intensive care and fluid therapy to combat the fatal effects of shock, decompression and if necessary, de-rotation of the stomach. In some cases, removal of the spleen (splenectomy) or resection of part of the stomach (partial gastrectomy) is required. Even with prompt treatment mortality rates can be high – published results range from 10% (Brockman 1995) to 33% mortality (Mackenzie 2010). The prognosis is better where there is dilation but no twisting (Brockman 1995). However, where gastrectomy and splenectomy are required the mortality rate has been reported as high as 55% (Brourman 1996).
The incidence of gastric dilation and volvulus can be influenced by selective breeding and management of feeding – avoid stress at mealtimes, feed more than once per day, do not feed from a height, slow down rate of eating. A gastropexy is a surgical procedure where a permanent adhesion is created between the stomach and the body wall. It is performed for the prevention of a gastric dilation and volvulus (GDV) either in animals suffering from an episode of GDV or as a preventative procedure. Dogs treated for GDV with de-rotation of the stomach but no gastropexy had a recurrence rate of 50%, whilst those treated with a gastropexy had a rate of less than 5% (Glickman 1997). A study of five predisposed breeds (Great Danes, Irish Setters, Rottweilers, Standard Poodles and Weimeraners). Ward, M.P (2003) found a reduced lifetime risk of mortality ranging from 2.2-fold in Rottweilers to 29.6-fold in Great Danes.
There are several different open abdominal techniques to achieve a gastropexy, however these require significant exposure of the abdomen to achieve the result. There are also laparoscopic-assisted procedures where the surgeon uses a telescope and camera to identify and grasp the stomach before suturing to a reduced abdominal incision up to 6cm long. However, the gold standard procedure is to perform the procedure entirely laparoscopically. While this technique requires significantly more skill and experience on the part of the surgeon, in such hands the comfort of the patient and recovery rate are much enhanced.
Laparoscopic gastropexy should be considered in at risk breeds. The procedure can be performed as a single procedure in male dogs or at the time of ovariectomy ovariohysterectomy in females.
- Brockman, J.D., Washabau, R.J., Drobatz, K.J., (1995) Canine gastric dilation-volvulus syndrome in a veterinary critical care unit: 295 cases (1986-1992) Journal of the American Veterinary Medical Association 207: 460-464
- Brourman, J.D., Schertel, E.R., Allen, D.A. et al (1996) Factors associated with perioperative mortality in dogs with surgically managed gastric dilatation-volvulus: 137 cases (1988-1993) Journal of the American Veterinary Medical Association 208: 1855-1858
- Evans, K.M., Adams, V.J. (2010) Mortality and morbidity due to gastric dilation-volvulus syndrome in pedigree dogs in the UK. Journal of Small Animal Practice 51: 376-381
- Glickman, L.T., Glickman, N.W., Schellenberg, D.B., Raghavan, M., Lee, T.L. (2000a) Incidence of and breed-related risk factors for gastric dilatation-volvulus in dogs. Journal of the American Veterinary Medical Association 216: 40-45
- Glickman, L.T., Glickman, N.W., Schellenberg, D.B., Raghavan, M., Lee, T.L. (2000b) Non dietary risk factors for gastric dilatation-volvulus in large and giant breed dogs. Journal of the American Veterinary Medical Association 217: 1492-1499
- Mackenzie, G., Barnhart, M., Kennedy, S. et al (2010) A retrospective study of factors influencing survival following surgery for gastric dilatation-volvulus syndrome in 306 dogs. Journal of the American Animal Hospital Association 46: 97-102
- Ward, M.P., Patronek, G.J., Glickman, L.L. (2003) Benefits of prophylactic gastropexy for dogs at risk of gastric dilation-volvulus. Prev Vet Med 60: 319-329