John Litterine-Kauffman, DVM
It is two in the morning. You have just been awoken by your yellow lab, Rufus, retching at the foot of your bed. He has been uncomfortable all night, but now he is gagging and retching as if something is stuck in his throat, but he cannot bring it up. His belly also seems bigger than you remember and feels tight when you go to calm him down. As a veterinarian working in an emergency clinic, this set of symptoms points to one thing – gastric dilatation and volvulus, better known as “GDV” or bloat.
In gastric dilatation and volvulus, the stomach twists on itself which causes obstruction of the gastrointestinal tract, as well as the blockage of blood flow from the extremities back to the heart. With the stomach twisted, there is no exit for the stomach contents, so it becomes bloated with gas and distends in size. Weakness and collapse can result due to the decreased blood return to the heart. As the stomach distends and its blood supply is disrupted, the stomach wall can become damaged and sections can even become necrotic, or die. Occasionally, a stomach will bloat without rotating, which is equally uncomfortable but far less life-threatening. To differentiate the two, your veterinarian will need an x-ray of your dogs abdomen, which will show the stomach either in its normal position or rotated.
Treatment of gastric dilatation and volvulus includes stabilization followed by surgery. The sooner treatments are started the better chance of recovery. Before taking Rufus into the operating room, most veterinarians will try to relieve the pressure in the stomach. This can be done by sedating Rufus and trying to pass a tube down into the stomach. In some cases, this cannot be done due to the rotation of the stomach. In these cases, a large needle can be passed through the skin into the stomach to relieve some of the tension. Unfortunately, using a stomach tube or needle to decompress the stomach does not allow a twisted stomach to return to its normal position, so surgery is still required. In surgery, the stomach will be moved back into its normal position and all other organs will be evaluated. In some cases, there is concurrent damage to the spleen. When this occurs, we remove the spleen during surgery. Most dogs won’t ever miss it! It is important to remember that GDV is a complicated and life threatening disease and even with prompt, aggressive veterinary care, some patients will not survive.
Obviously, with a condition as dangerous (and expensive) as GDV, prevention is key! For large and giant breed dogs, we recommend a procedure called a gastropexy. This is a minor surgery in which the stomach is tacked to the body wall using thick suture. The stomach and body wall will scar to each other, holding the stomach in its appropriate place. In most cases, this will prevent GDV, or the ability of the stomach to rotate. This procedure can be performed during a spay or castration, and can even be performed as a minimally-invasive procedure using small “keyhole” incisions and a camera.
Many studies have searched to find underlying causes of gastric dilatation and volvulus, looking at everything from types of food, speed of eating, geographical location, temperament, age, sex, and pretty much every other factor you could think of! Thus far, the only definitive risk factor is large and giant breed dogs, or those labeled as “deep-chested.” It is for this reason that veterinarians will recommend that any dog that fits this description has a gastropexy performed. If you have a puppy matching this description, you can ask your family veterinarian about having a gastropexy performed with your pet’s spay or neuter.
Gastric dilatation and volvulus is a true emergency. It is scary for us as owners, dangerous for our furry friends, and can be significantly prevented through gastropexy. In any large or giant breed dog, pain or discomfort around the abdomen, retching without vomiting, and abdominal distention should immediately be evaluated by a veterinarian. Hopefully, as more owners opt for gastropexy, we can help prevent this emergency.