Managing gastric dilatation and volvulus – a true emergency

Presenter – Dr Henry L’Eplattenier, PhD, Dipl ECVS, MRCVS, ECVS & RCVS Recognised Specialist in Small Animal Surgery and European Specialist in Small Animal Surgery. Dr L’Eplattenier is a consultant surgeon at VRCC Referral Centre, Laindon, Essex
The phone goes in the middle of the night, Mrs Jone’s bloated Great Dane is trying to be sick and not bringing anything up. With clinical signs like these, we all know the night ahead is likely to be very long, and with GDVs having a mortality rate of between 10-17% the outcome may not always be positive. So any advice given by Dr Henry L’Eplattenier in last week’s webinar to try and increase the chances of these ‘true emergencies’ was an opportunity not to be missed.

To expect the unexpected was one of the many ‘top tips’ given by Dr L’Eplattenier for diagnosing and treating GDVs. It might be expected to see these cases in large breed, deep chested dogs, but sometimes smaller breeds may be affected, with a Bassett hound being cited as an example. Also don’t be surprised if some come in looking as bright as buttons and still wagging their tail – collapsed dogs may be in the majority but there are always exceptions.

Decompression of the stomach and shock therapy are the main aim of pre-operative management of GDVs. Dr L’Eplattenier suggested using an orogastric tube as the most rapid technique for achieving gastric decompression, but was most useful in recumbent dogs where sedation is not necessary. If dogs are not stable enough to sedate but still lively enough to make tubing difficult, gastric decompression can be achieved by using multiple large bore catheters placed in tympanic areas just caudal to the last rib.

The only treatment for GDV is surgery and should not be delayed. The possible exception to this is if after gastric decompression the volvulus has resolved. These cases could be (but not ideally) left overnight but should always undergo surgery in the morning as the rate of recurrence in these cases is very high.

Dr. L’Eplattenier also discussed techniques for gastropexy and explained that no study has found any clinical advantage to any particular technique. He then went on to discuss his personal preference which he considered to be a relatively quick, easy and effective, the incisional gastropexy.

This webinar provided a really succinct and practical overview of managing the GDV patient and hopefully the next time I get that dreaded call in the middle of the night I can put all this advice to good use. This should not only make Mrs Jones a happy client but I will also benefit from a splash of job satisfaction too.

The Stethoscope (MRCVS)