SURGICAL MANAGEMENT OF GASTRIC DILATATION AND VOLVULUS WITH PYLORIC OBSTRUCTION IN A DOG

Naveen Kumar Verma1, P.D.S. Raghuvanshi1, Deepesh Gautam1, Rajesh Kumar1,
Pankaj Patel1, A.C. Saxena2, Amarpal3 and P. Kinjavdekar4
1Ph.D. Scholar, 2 Scientist, 4Principal Scientist, 3Principal Scientist & Head; Division of Surgery, Indian Veterinary
Research Institute, Izatnagar (Bareilly)-243122, (U.P.).
[Received: 30.11.2018; Accepted: 28.5.2019]
{DOI 10.29005/IJCP.2019.11.1.070-072}

An eight-year-old male Labrador retriever dog was presented to Referral Veterinary Polyclinic, Indian
Veterinary Research Institute, Bareilly in recumbent condition having distended abdomen with a complaint of bloat and
difficult breathing after intake of meal. Radiographic examination revealed distended gas filled stomach. On the basis
of patient history, radiographic and clinical examination it was diagnosed as a case of Gastric dilatation and volvulus.
Surgery was planned under general anesthesia. A cranial to middle mid line coeliotomy was performed and gastric
decompression done by gastrotomy and gastric contents were evacuated. While performing gastrotomy, it was found
that pylorus was obstructed with soapnut. Obstructed mass was removed and gastrotomy incision was closed.
Thereafter, stomach was repositioned to its normal anatomical position by gentle handling followed by gastropexy.
Abdominal cavity was lavaged thoroughly with warm normal saline and surgical incision was closed in standard
manner. Post-operative treatment included antibiotics and analgesics together with fluid therapy given for 5 days. The
dog showed uneventful recovery.
Keywords: Gastric dilation and volvulus, Gastropexy, Pyloric obstruction, Soapnut.

Gastric dilation and volvulus (GDV) is a rapidly progressive devastating condition of dogs predominantly encountered in speciality and emergency practice. In dogs, GDV is characterized by gaseous distension
of the stomach and rotation of the stomach around its long axis. It is commonly associated with feeding of large meals which may result in stomach dilatation due to accumulation of food and gas; it may get to a point where neither food nor gas may be expelled. GDV is invariably associated with varying degrees of hypovolemic or septic
shock, ventilation perfusion mismatch, and myocardial dysfunction. It is common in certain large and giant purebred dogs; and deep-chested breeds are especially at risk (Van Kruiningen et al., 2013). Mortality rates
in dogs range from 10 to 60 percent, even with treatment (Allen and Paul, 2014).

It was reported that genetics/breed of dog, food texture/quantity/quality/ingredients, emotional state, age and presence of foreign body in GIT are the several predisposing factors for GDV (Maki et al., 2017). De
Battisti et al., (2012) reported that the presence of a gastric foreign body may increase the likelihood of developing GDV by a minimum of 97.9%. Gastropexy, a technique, commonly used to securely adhere the stomach to the body is reported to be effective and decreases the recurrence of GDV from 80% to less than 5% (Allen and Paul, 2014). Generally, GDV patients have worse prognosis and many may die if immediate medical attention including
surgical correction is not performed (Allen and Paul, 2014).

Case History and Observations
An eight-year-old male Labrador retriever dog weighing 48 kg was presented to Referral Veterinary Polyclinic, Indian Veterinary Research Institute, Bareilly in recumbent condition having distended abdomen with a complaint of bloat and difficult breathing after intake of meal. Radiographic examination revealed typical ‘‘double bubble’’ appearance of stomach filled with gas (Fig.1). On the basis of patient history, radiographic and clinical examination
it was diagnosed as a case of Gastric dilatation and volvulus (GDV).

Surgical Treatment
The dog was prepared for aseptic surgery and pre-anaesthetized with Atropine sulphate 0.04 mg/kg body weight S/C, Butorphanol 0.2 mg/kg body weight I/V and Diazepam 0.25 mg/kg body weight I/V. The general anesthesia was induced with Ketamine hydrochloride 5 mg/kg body weight I/V and maintained with Ketamine
hydrochloride 5mg/kg body weight and Diazepam 0.25mg/kg body weight I/V.

The dog was restrained in dorsal recumbancy. A cranial to middle mid line coeliotomy was performed and gastric
decompression done by gastrotomy and gastric contents were evacuated after exteriorizing the stomach from the abdominal cavity (Fig.2 and 3). During gastrotomy, it was found that pylorus was obstructed with
soapnut (Fig.4). Obstructing mass was removed and gastrotomy incision was closed in double layered Lembert suture pattern using vicryl 1/0. Stomach was then de-torted and repositioned to its normal anatomical
position by gentle handling followed by gastropexy with left lateral abdominal wall using simple interrupted suture pattern. Abdominal cavity was lavaged thoroughly with warm normal saline and surgical incision was closed in a routine manner.

Results and Discussion
Post operatively ceftriaxone 20mg/kg I/V for 7 days, meloxicam 0.5mg/kg I/M for 3 days were administered. The animal was maintained by parenteral administration of Ringers Lactate and Dextrose 5% daily for five days. Sutures were removed on 10th postoperative day and animal recovered uneventfully.

GDV, also known as acute gastric dilatation (AGD) or bloat, is a one of the acute life threatening medical emergency
requiring prompt medical attention for successful outcome. GDV occurs when the pylorus is mispositioned. In the present case, we also found the gastric foreign body (soapnut) obstructing the pylorus. Accurate diagnosis and appropriate treatment strategy is vital for successful clinical outcome. Marked distended abdomen, dorsal
displacement of the antrum with suspected compartmentalization, narrowing of the caudal vena cava and suspected microcardia due to reduced return of blood from the abdominal viscera and hypovolemia are the typical radiographic findings for GDV. Surgical intervention involves gastric decompression and repositioning of stomach
in its normal anatomic position In conclusion, early diagnosis and surgical correction are vital for the survival of
dogs suffering from gastric dilatation and volvulus.

References
Allen, P., and Paul, A. (2014). Gastropexy for prevention of gastric dilatation-volvulus in dogs: history and techniques. Topics in Companion Animal Medicine, 29(3): 77- 80.

De Battisti, A., Toscano, M.J. and Formaggini, L. (2012). Gastric foreign body as a risk factor for gastric dilatation
and volvulus in dogs. J. Amer. Vet. Med. Assoc., 241(9): 1190-1193.

Maki, L.C., Males, K.N., Byrnes, M.J., El- Saad, A.A. and Coronado, G.S. (2017). Incidence of gastric dilatation-volvulus following a splenectomy in 238 dogs. The Canad. Vet. J., 58(12): 1275.

Van Kruiningen, H.J., Gargamelli, C., Havier, J., Frueh, S., Jin, L. and Suib, S. (2013). Stomach gas analyses in canine acute gastric dilatation with volvulus. J. Vet. Internal Med., 27(5): 1260-1261.

Leave a comment

Your email address will not be published. Required fields are marked *

RSS
Follow by Email
Facebook
Google+
http://www.indianjournalofcaninepractice.org/2019/06/01/surgical-management-of-gastric-dilatation-and-volvulus-with-pyloric-obstruction-in-a-dog">
Twitter
error: Content is protected !!