Rufus is a 5 year old German Shorthaired Pointer who had to undergo emergency surgery to correct Gastric Dilatation and Volvulus (GDV) or 'bloat'. With the typical rapid progression of clinical signs, Rufus went downhill within minutes. He was rushed to our clinic for assessment as his abdomen was distended and he was certainly not feeling well. In the time it took for our team to assess him and get him ready for x-rays, Rufus deteriorated from walking miserably through the front door to lying down listless. Time was of the essence - we had to move quick.
Gastric Dilatation and Volvulus (GDV) is a syndrome mainly affecting large dogs however it has been reported in smaller breeds and the occasional cat. The ultimate cause of GDV is as yet unknown, however there are risk factors associated with the syndrome. GDV involves ‘dilatation’, with gas build-up in the stomach and ‘bloat’, as well as ‘volvulus’, where the stomach rotates on its attachments within the abdomen. This rotation can be anywhere from 90-360 degrees. As a result of the rotation, the blood supply to the stomach is cut off, leading to death of the stomach wall if not corrected. The stomach is also connected by ligaments to the spleen. Rotation applies excessive tension on the tissues of the spleen, either causing a rupture and severe bleeding or pulling off its attachments to the body wall. Bloating causes excessive pressure within the abdomen that cuts off the blood supply returning to the heart, reducing the amount of oxygen that reaches the rest of the body and reducing the space that the diaphragm has to open up the chest. This then affects the heart and lungs. A GDV case involves the whole body and can very quickly result in death.
X-rays were taken of Rufus’ abdomen and gave us a very clear diagnosis of the condition. The stomach was extremely bloated with gas, taking up more than ⅔ of the space in the abdomen, and had a characteristic 'bilobed' appearance indicating the rotation of the stomach. It was clear that Rufus would need emergency treatment and surgery to save his life. Whilst preparing him for surgery a large-bore needle was inserted into the stomach to allow some gas to escape, reducing the pressure within the abdomen and allowing some of the trapped blood to return to circulation. Rufus was prepared for surgery and taken straight to theatre.
In surgery, we used an 'orogastric' (mouth-to-stomach) tube to help empty the stomach contents and gas while the surgeon rotated the stomach back into its normal position. Luckily for Rufus, his stomach was still healthy enough and the wall was still intact. Unfortunately his spleen had been pulled off all of its attaching ligaments and had to be removed. In most older dogs, the spleen can be removed without major consequences on the rest of the body. This is occasionally performed to remove tumours in the spleen or in cases of splenic rupture. To prevent further episodes of GDV, a gastropexy was performed, stitching the stomach to the abdominal wall where rotation would normally occur in cases of GDV. Pre, intra and post-operative fluids were essential in keeping Rufus’ blood pressure high enough to maintain circulation and help his recovery. Strong pain relief was administered to Rufus to ensure the most comfortable recovery from such a large surgery and life-threatening condition.
Fortunately for Rufus, we were able to correct the GDV rapidly and he recovered well in hospital on a drip overnight. He began eating the next day once he had woken up completely from the anaesthetic and continued to recover his spirits in figurative leaps and bounds. (Obviously, we did not want him jumping around after such a major surgery!)
Large breed dogs are prone to GDV, especially those with deep chests, such as Great Danes, Weimeraners, Pointers, German Shepherds and St Bernards, although any breed can be affected. Other risk factors include previous GDV episodes, overeating, eating once a day and exercise immediately after eating. Avoiding these factors can help to prevent occurrences of GDV. In addition, we can perform prophylactic (preventative) gastropexies - either by minimally invasive surgery or through the abdomen. This can be performed at any age, even during a de-sexing procedure. Gastropexies are recommended in at-risk breeds to drastically reduce the risk of the potentially life-threatening condition. Any of our vets would be happy to answer any questions you have about GDV and prophylactic gastropexies.
Rufus is lucky to be alive and benefited immensely from very quick assessment and emergency treatment by our team. He has since made a full recovery from the condition and is back to his happy active self. There have been no lasting side effects from the GDV and he is now more protected from a second event by the gastropexy.