CPD ACCREDITED ARTICLE magnitude of the volvulus . Perforation of a compromised stomach can happen with placing an orogastric tube , but measuring from the chin to the xiphoid before introducing the tube may help prevent stomach perforation . To help intubation , it may be beneficial to stand the dog on its hindlimbs .
If the intubation is successful , stomach lavage is required to empty the stomach . Evaluate the color and content of the fluid coming back after stomach lavage . Hemorrhagic fluid or black necrotic tissue fragments are indications of stomach wall necrosis .
If intubation is not successful , percutaneous gastrocentesis with 18-ga needles is an option to decompress the stomach . Percutaneous gastrocentesis is performed on the right side . It is important to make sure the spleen has not been displaced in the right side of the abdomen . Percussion over the site of gastrocentesis with a dull sound would tend to indicate that the spleen has been displaced . If the spleen is present , gastrocentesis cannot be performed . Abdominal contamination is a risk after percutaneous gastrocentesis , especially if large trocars are used . After percutaneous gastrocentesis , orogastric intubation can be tried again . the pylorus with your right hand and pull it ventrally toward the abdominal incision while pushing the fundus dorsally into the abdominal cavity with your left hand .
The spleen follows the motion of the stomach . If splenic torsion is present , perform a splenectomy without untwisting the vascular pedicle .
After derotation , evaluate the stomach and spleen for ischemic injuries . Usually , the spleen shows signs of venous congestion that resorbs quickly after derotation of the stomach . Splenectomy is indicated if thrombosis of the splenic artery is present . The absence of the slipping of the mucosa and submucosa is another criterion .
Evaluating gastric wall perfusion is difficult . About 20 % of dogs with GDV have a devitalised gastric wall requiring gastrectomy . 15 Ischemic injury occurs most commonly in the fundic area along the greater curvature . No objective criteria exist to evaluate the gastric wall . The absence of a peristaltic wave , a pale greenish-to-gray serosal color , a thin gastric wall , the absence of the slipping
Additional emergency care Cardiac rhythm needs to be evaluated before surgery . Atrial fibrillation , supraventricular tachycardia , and ventricular tachycardia are the most common arrhythmias associated with GDV . 9 , 15 , 20 , 21 Usually the arrhythmias occur postoperatively . Correction of acid-base imbalances might help correct the arrhythmias . A blood gas analysis will be required to understand the acid-base status of the patient since dogs with GDV can be acidotic or alkalotic . 14
Surgical Treatment Surgical intervention is required after the patient is medically stabilised and is recommended as soon as possible . 15 Delayed surgery increases the potential for gastric wall oedema and necrosis and venous stasis , especially if the stomach is rotated 360 degrees . If the surgery is delayed , cardiac arrhythmias can develop . Most dogs that have arrhythmias develop them within 36 hours after the gastric dilatation episode .
The purpose of this surgery is to derotate the stomach , evaluate the stomach wall and spleen for ischemic injury , and perform a gastropexy .
Derotation To begin the surgery , place the dog in dorsal recumbency , and perform a midline celiotomy . The surgeon should stay on the dog ' s right side . Upon opening the abdominal cavity , omentum will be covering the stomach , which confirms the GDV diagnosis . The stomach can be decompressed again before derotation with a large orogastric tube . After identifying the pylorus and the fundus , grasp
3 . Necrosis of the body of the stomach along the greater curvature . The dark color and absence of peristalsis are two criteria used to evaluate the stomach wall ’ s viability .
of the mucosa and submucosa when tested , and lack of bleeding after a partial thickness incision are signs of gastric wall devitalisation ( Figure 3 ).
Gastrectomy If the body of the stomach along the greater curvature of the stomach wall is necrotic , a gastrectomy is required . Two options are available : gastrectomy with either traditional suture technique or stapling suture .
Pack the stomach off from the abdominal cavity with moistened laparotomy sponges . Retract the healthy stomach with stay sutures to prevent gastric spillage .
If a suture technique is used , ligation of the branches of the short gastric arteries and left gastroepiploic artery supplying the area is required . Resect the necrotic gas-
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