Gastric dilation (GDV) case
Lucky, a 5 year old, male Weimaraner presented to us with a history of vomiting over the past 24 hours. On physical examination, Lucky’s gums were pale and he had severe abdominal pain.
To get a better understanding of what was causing Lucky’s very painful abdomen, we took some x-rays of his abdomen. These revealed that he had an extremely distended, gas filled stomach (gastric dilation). In addition, a number of large bone fragments were also identified that were blocking the outflow tract of the stomach.
With these findings, we were able to conclude that Lucky had severe gastric dilation secondary to obstruction, and potentially volvulus. Once diagnosed, we had to respond quickly in order to maintain adequate blood flow to the heart and protect against shock. To achieve this, Lucky was placed on an IV drip and given aggressive fluid therapy. These fluids would only provide temporary stabilisation. To decompress the stomach and remove the bone fragments, Lucky required surgery.
In the following hours we gave Lucky some sedatives (acepromazine and butorphanol) and anaesthetised him using Alfaxan and Isoflurane. A stomach tube was then placed into the stomach, from the mouth, and 1.5 litres of foul smelling fluid siphoned out.
The abdomen was then opened up. To protect against future episodes of GDV, the stomach wall was permanently adhered to the right body wall (gastropexy). This was achieved using a surgical technique known as a circumcostal gastropexy. To perform this, a small flap was created using the outer layers of the stomach wall (the seromuscular layer). The flap was then passed through a tunnel made beneath the eleventh or twelfth rib before being re-sutured to the area of the stomach wall from which it was created. With the stomach wall now anchored to the rib, it will not be able to twist and therefore Lucky is protected against GDV returning.
With the stomach anchored, our next step was to remove the bone fragments from the stomach. To do this, a small incision was made in the wall of the stomach (gastrotomy). With the stomach open, we were able to locate and remove the several pieces of gristle and bone that were obstructing the outflow of the stomach. The remaining stomach contents were then suctioned and the stomach wall closed using a Connell-Cushing closure technique. This technique involves two inverting layers of continuous sutures. The pattern helps to create a strong, water tight seal, which is a very important consideration whenever a fluid containing organ capable of great expansion, such as the stomach, is entered. Following closure of the stomach, the abdomen was closed, and Lucky woken up from his anaesthetic.
At checkup a few days after his operation Lucky was doing very well. His appetite returned to normal and his vomiting ceased. Most importantly, to this day Lucky has had no other episodes of GDV.
Gastric Dilation and Volvulus