Signalment & History
- Patient presents after an acute episode of non-productive retching. The patient’s abdomen is painful and distended.
- Due to concern for aspiration pneumonia, a 3-view thoracic study was performed. The following images were selected from the study.
Findings
- There is a gastric dilatation volvulus with dorsal displacement of the pylorus and ventral displacement of the fundus.
- Free air is present in the cranial abdomen causing increased serosal margin detail.
- There is a small cardiac silhouette and small pulmonary vasculature.
- There is ventral spondylosis deformans and degenerative changes of the glenohumeral joints.
- There is a metallic pellet noted in the right ventral abdomen.
Diagnosis
- Gastric dilatation and volvulus with pneumoperitoneum
- Hypovolemia
- Metallic ballistic foreign body
Conclusions
Gastric dilatation and volvulus
- Gastric-dilation volvulus (GDV) is a life-threatening condition in dogs during which the stomach dilates and rotates around its axis. Survival rates vary from 73-90% with time spent stabilizing the patient prior to surgery having a positive impact on survival.
- GDV occurs most commonly in large breed, deep-chested dogs such as Great Danes, Irish Setters, Weimaraners, Standard Poodles, and Saint Bernards.
- GDVs can present with varying degrees of volvulus and may not demonstrate the classic “Double Bubble” shape of the stomach. Combining radiographic information with clinical signs will help to increase suspicion in less obvious cases.
- Clinical signs include unproductive retching, restlessness, pacing, salivation, respiratory distress, depression, abdominal pain and abdominal distension. Signs can progress rapidly.
- As the stomach distends, intraabdominal pressure is increased and can lead to decreased venous return to the heart. Early stabilization of the patient with aggressive fluid therapy and decompression of the stomach is imperative.
- The right lateral radiographic view should be the first view that you take because the pylorus becomes air-filled and displaces to the left. This view is most likely to show the typical “Double Bubble, Popeye arm, or Smurf Hat” shape of the stomach. It is important to check for pneumoperitoneum on radiographs as this may indicate gastric rupture.
References
Cornell, K. Stomach. 2018;4648–4658. In Veterinary Surgery Small Animal, 2E. Ed. Johnston SA, Tobias, KM.
