Deets

Signalment: 4YR, intact male, Belgian Sheepdog

History: Acute onset of abdominal discomfort noticed by owner several hours prior to presentation. “Deets” had been seen crouching in a “praying” posture and also was acting unusual. No retching, vomiting or diarrhea had been observed and there had been no history of dietary indiscretion.

Exam: Mucous membrane color was slightly muddy, femoral pulses reduced, and very mild stomach distension was observed on abdominal palpation. Hydration status was normal and “Deets” was very alert and active in the examination room.

Diagnostics: CBC, chemistry analysis, and electrocardiogram were normal. Radiographs revealed abnormal gas accumulation with compartmentalization in the stomach suggesting gastric distension and volvulus.

Diagnosis: Gastric distension and volvulus (GDV)

“Deets” owner, Lisa, immediately approved the necessary resuscitation and surgery to correct this life threatening condition. An intravenous catheter was placed for rapid administration of iv-fluids, antibiotics, steroids and pain medications. “Deets” visit to the emergency clinic had quickly become a fight for his life. Within hours after arrival to the emergency clinic, “Deets” was being prepped for surgery. Pulse oximetry, apnea monitors, and electrocardiogram continuously monitored his cardiovascular status intra-operatively. Upon entering the abdomen, the stomach was “de-rotated” to its normal anatomical position. The spleen also had torsed with the stomach and also had to be untwisted and placed to its normal position. To prevent recurrence, the stomach is “tacked” or sutured (incisional gastropexy) to the right side of the abdominal wall. This procedure is performed to hold the stomach in place and does not interfere with normal digestive processes.
Due to Lisa’s rapid recognition of a problem and awareness of the severity of a GDV condition, no complications were encountered perioperatively. “Deets” was discharged and is expected to live a normal and healthy life.

Discussion:
Etiology: The cause of GDV is not entirely understood but it has been found that large breed dogs that are fed once daily, fast eaters and those that are underweight or lean are more prone to develop the condition Intact males seem to be overly represented and those dogs with a history of inflammatory bowel disease may also be at a higher risk. Any condition that prevents normal gastric motility resulting in distension of the stomach and swallowing of air may progress to a torsion. Although uncommon, obstruction of the pylorus (outflow tract) of the stomach can lead to the condition.

Signs: Owners often report retching (non-productive vomiting), abdominal distension, pain, rapid breathing, dark mucous membranes (gums) and rapid progression of weakness.

Effects: The severely distended and rotated stomach results in reduced blood circulation to the stomach wall and also causes “sludgeing” of blood in the rear half of the body. The poor circulation results in loss of the integrity of the stomach wall, eventual absorption of bacteria and toxins into the bloodstream from the gastrointestinal tract, build up of toxic metabolic by-products, and loss of blood pressure. The progression of shock occurs quite rapidly if left untreated.

Following the decompression and de-rotation of the stomach, the release of toxins into the general circulation may lead to fatal heart arrythmias or massive “stroke-like” syndromes.

Treatment: GDV is a condition requiring immediate medical stabilization and surgical correction.

Prognosis: If rapid diagnosis is made, ~85% of dogs usually recover. Dogs with severe necrosis (devitalized areas) of the stomach wall usually encounter severe and sometimes fatal complications.

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