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Daisy's life-threatening twisted stomach

This is Daisy, a Weimaraner, who was brought in as an emergency to the Queens Road Hospital recently with a swollen abdomen.

Daisy had her breakfast and a walk as normal in the morning, but by mid-morning she was very uncomfortable and distressed. Fortunately her owners realised something potentially serious was wrong and wasted no time in bringing her into the practice to be seen. On examination she was dull, hunched up and had a swollen drum-like abdomen. During the examination she had several bouts of unproductive retching. These signs are the classic presentation of a twisted stomach, normally referred to as gastric dilatation and volvulus (GDV).

Informative image: weimeraner, GDV, swollen abdomen, emergency vet treatmentThese patients are true emergencies as GDV can be rapidly fatal within hours. The stomach fills with air and twists around within the abdomen. This twisting collapses the oesophagus and the pyloric outflow and prevents fluid and gas leaving the stomach or being vomited up. Food in the stomach ferments, producing more gas and more fluid is secreted into the stomach. As the stomach expands, the abdominal veins are compressed preventing blood returning to the heart and the lungs are squashed, making breathing harder. As the stomach rotates, some blood vessels tear and there is bleeding into the abdomen. Occasionally part of the stomach or the spleen loses its blood supply and starts to die off. All these things contribute to circulatory shock and low blood pressure which can lead to circulatory collapse and death within 4-6 hours.

Initial emergency treatment focuses on maintaining the circulation by improving blood pressure, followed by decompression of the stomach to release air. Daisy had drip lines placed in both front legs and received strong painkillers as intravenous fluids were started. After a short time, a stomach tube was passed to release some air from her stomach, although this is not always possible in less compliant patients. Surgery is also essential in GDV patients to de-rotate the stomach and suture the stomach in a normal position to prevent recurrence of the twisting (“gastropexy”). The timing of surgery is controversial, but it is now widely accepted that emergency stabilisation of GDV cases is imperative and that spending a few hours treating the circulatory shock is time well spent; GDV dogs die of circulatory collapse and shock, not because of a delay in surgery to de-rotate the stomach. Fortunately because Daisy was presented very promptly, her shock was successfully managed and after a few hours a definitive surgery could be performed to return the stomach to a normal position and perform a gastropexy to prevent the stomach rotating in the future. Daisy recovered well after surgery and was monitored carefully overnight for various other problems which can occur after surgery (such as bleeding disorders, cardiac arrhythmias and ileus). She was discharged the following day to a very relieved owner and went on to make a full recovery.

Daisy was lucky as not all dogs survive a GDV. Over the years the survival rate has improved from 50% to 80-90%, but this depends on how promptly dogs are presented for treatment and the facilities available for treatment. It is a common cause of death in certain larger breeds, indeed a recent UK study (JSAP 2010) suggests that 19% of all Great Danes, 12% of all Weimaraners and 20% of all Chow chows die of GDV. That is deaths and apparently excludes dogs successfully treated for the condition. Known risk factors for GDV include:

  • Being a large or giant breed
  • Having a close relative (parent or sibling) who had a GDV
  • Having a narrow, deep chest
  • Swallowing air or “gulping” food
  • Being an anxious or “stressy” dog
  • Experiencing a recent episode of stress (e.g. being kennelled, car journeys, dog shows, being hospitalised in the   vets)
  • Feeding one meal a day

Occasionally larger dogs at high risk for GDV undergo a preventative treatment called a prophylactic gastropexy. This involves permanently fixing part of the stomach to the body wall to prevent the stomach rotating, virtually eliminating the risk of GDV. This used to be done as an open abdominal surgery, but it is now possible to perform this procedure with laparoscopic assistance, essentially making it a minimally invasive procedure. Typically it may be performed at the same time as a laparoscopic spay surgery in young female dogs of breeds at higher risk for GDV.

Thank you to Daisy’s owners for allowing us to share her story. 

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