Gastric dilation and volvulus is a malposition of the stomach, caused by rotation around the ligaments and vasculature. It causes acute presentation and shock resulting from vascular compromise to the stomach. GDV is commonly diagnosed with radiographs in the acute care setting.
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Terminology
Both gastric dilation and volvulus (GDV) and gastric torsion are used to describe the malposition of the stomach.
Epidemiology
Gastric dilation and volvulus occurs commonly in dogs, and is uncommon in cats. Guinea pigs may also be affected.
The stomach fills with gas, along with food and/or fluid, causing distension. This may be due to aerophagia, carbon dioxide accumulation, or other factors 1. The volvulus occurs after dilation and inability of the stomach to empty contents.
Risk factors
Risk factors in dogs can include giant breed with deep chest, fewer meals per day, prior splenectomy, and kenneling 1.
Clinical presentation
Clinical signs include abdominal discomfort, retching or unproductive vomiting, abdominal distension, and shock.
Macroscopic appearance
The stomach rotates clockwise when viewed from the caudal perspective. The fundus rotates ventrally and to the right, and the pylorus rotates dorsally and to the left. The degree of rotation can be 180-360 degrees.
Radiographic features
Radiographic features are enlargement of the stomach with food, gas, and/or fluid, and malposition of the fundus and pylorus.
Radiography
Radiography is the most commonly used diagnostic tool due to its wide availability in the emergency setting, and quick results.
The stomach is enlarged with gas and food. On the right lateral projection, the pylorus (smaller compartment) is displaced dorsally relative to the fundus, and may contain gas. The fundus will be positioned ventrally, and rugal folds may be visible to help identify this larger compartment.
A ventrodorsal projection may also be taken if the animal is stable or the diagnosis is not evident on the lateral projection. The pylorus will be displaced to the left of midline cranial to the fundus, and the fundus will be displaced to the right. The duodenum may occasionally be seen tracking to the pylorus to the left of midline.
The spleen is often displaced caudally and ventrally as it is ligamentously attached to the stomach. Enlargment of the spleen may suggest splenic torsion.
The small intestine is often displaced caudally by the increased volume of the stomach.
Ultrasound
The frequent presence of large amounts of gas preclude ultrasonographic imaging.
Radiology report
The radiology report should include a description of the primary lesion (GDV), secondary findings (spleen, thoracic findings, pneumatosis), and an assessment of surgical need. Complications such as gastric pneumatosis, effusion, and peritoneal free gas should be highlighted and incorporated into the evidence for surgical intervention.
Morphology
Description of the position of the stomach includes the relative positions of the fundus and pylorus, the position of the duodenum if visible, and the statement of gastric malposition.
Relationship to/involvement of
Spleen, small intestine
Treatment and prognosis
Treatment is surgical depending on owner consent and the prognosis depending on the clinical assessment. The stomach is usually derotated and inspected for necrosis, and a gastropexy is performed to prevent future occurrences of GDV. Shock and peritonitis decrease the prognosis for surgical cure.
Complications
Complications occur from decreased venous return by the caudal vena cava and portal vein, leading to ischemia of abdominal organs and circulatory shock. Cardiac arrhythmia may also occur 1.
Pneumatosis of the gastric wall may represent gastric pneumatosis from tearing of the mucosa, or gastric emphysema from necrosis of the gastric wall 2.
Megaesophagus and aspiration pneumonia may be identified in the thorax secondary to vomiting and GDV.
Differential diagnosis
The main differential diagnosis is gastric dilation without volvulus. The stomach is enlarged in both cases, and finding the relative positions of pylorus and fundus is key to differentiating these disorders.
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