Gastric Dilatation

Gastric Dilatation–Volvulus (GDV) is a rapidly developing, life-threatening emergency in dogs that requires immediate veterinary intervention. The condition has multiple contributing factors but is most frequently associated with the rapid consumption of large meals. The accumulation of food and gas causes marked enlargement and expansion of the stomach, which can result in several serious consequences, including:

• obstruction of normal blood return from the abdominal organs to the heart
• compromised blood supply to the stomach lining
• rupture of the stomach wall
• compression of the diaphragm, limiting lung expansion and reducing the ability to breathe normally

In addition to dilation, the stomach may rotate around its axis, a condition referred to as gastric volvulus. This twisting can obstruct blood flow to both the stomach and the spleen. As gastric dilation progresses and systemic effects persist, secondary complications may develop.

Reduced respiratory function and decreased cardiac output throughout the disease process impair oxygen delivery to tissues (hypoxia), which can lead to cellular death in vital organs such as the liver and kidneys. Cardiac arrhythmias (irregular heart rhythms) are commonly observed as a result of hypoxia. The lining of the entire gastrointestinal tract is also at risk of ischemia and tissue sloughing. When the gastrointestinal tract becomes devitalized, bacteria may enter the bloodstream, leading to bacteremia and potentially sepsis.

Numerous studies have evaluated risk factors associated with gastric dilatation and volvulus in dogs. Although the syndrome is not fully understood, it is known to be associated with dogs that:

• have a deep-chested conformation (increased thoracic height-to-width ratio),
• are fed one large meal per day,
• are older,
• have close relatives that have previously experienced GDV.

Additional factors thought to increase risk include elevated feeding bowls, previous splenectomy, large or giant breed size, and stress. A 2006 study also found that dogs fed dry diets listing oils (such as sunflower oil or animal fat) among the first four ingredients may be at increased risk, particularly if they already belong to a high-risk group.

Although GDV has been reported in nearly all dog breeds, those most commonly affected include Great Danes, Weimaraners, Saint Bernards, Irish Setters, and Gordon Setters.

Early clinical signs are often related to abdominal discomfort and may include:

• anxiety or frequent looking at the abdomen,
• standing and stretching,
• excessive drooling,
• abdominal enlargement,
• repeated retching without producing vomit.

As the condition progresses, affected dogs may begin panting, show pronounced abdominal distension, become weak, collapse, or lie down unable to rise. Physical examination findings commonly include elevated heart and respiratory rates, weak pulse quality, delayed capillary refill time, and noticeable abdominal distension.

Any pet showing these signs should be examined by a veterinarian immediately. Once GDV is diagnosed, surgical intervention is required. Stabilization and surgical treatment are most successful when initiated early, as mortality rates increase with disease severity. Referral to an ACVS board-certified veterinary surgeon is often recommended.

Most veterinarians will begin evaluation with blood tests including a complete blood count (CBC), serum chemistry panel, electrolyte analysis, and urinalysis to assess metabolic disturbances and rule out other diseases with similar presentations. Abdominal radiographs are used to confirm the diagnosis (Figure 1). An electrocardiogram (ECG) is commonly performed to detect cardiac arrhythmias, which frequently develop later in the disease course. Blood gas analysis is also often used to assess the extent of respiratory compromise. Additional diagnostic tests may be recommended based on the patient’s condition.

Due to the cardiovascular instability associated with GDV, most patients require preoperative stabilization, including intravenous fluid therapy and oxygen supplementation, prior to general anesthesia. If gastric rotation has stretched or damaged splenic blood vessels, blood transfusions may be necessary to manage ongoing hemorrhage.

Gastric decompression is typically performed by passing a tube through the esophagus into the stomach to release accumulated gas and fluid. This may be followed by gastric lavage to remove residual food material. In some cases, a needle or catheter is placed through the body wall into the stomach to release air and facilitate tube placement. The timing of anesthesia and surgery depends on the patient’s stability and the surgeon’s clinical judgment.

Surgical treatment involves complete exploration of the abdominal cavity and correction of the stomach rotation. The viability of the stomach wall, spleen, and other abdominal organs is assessed. If tissue damage is severe, partial removal of the stomach (partial gastrectomy) or spleen (splenectomy) may be required. Once the stomach is repositioned correctly, it is permanently attached to the abdominal wall in a procedure known as gastropexy, which helps prevent future volvulus if gastric dilation recurs.

Potential intraoperative and postoperative complications include hypotension, hemorrhage, surgical site infection, suture dehiscence, cardiac arrhythmias, shock, and death. Most pets remain hospitalized for several days following surgery and receive supportive care. Continuous monitoring of vital signs, including cardiac rhythm, is common. While transient arrhythmias are frequently observed, they often resolve without specific treatment.

Severe postoperative complications may be related to reperfusion injury or prolonged shock. Reperfusion injury occurs when toxic metabolites are suddenly released from the stomach after derotation, potentially causing arrhythmias, acute kidney injury, or liver failure. Extended periods of shock may result in organ dysfunction, clotting disorders, or death. Increased disease severity and longer duration prior to treatment are associated with higher complication and mortality rates.

The overall reported mortality rate for GDV is approximately 15%. Factors associated with increased mortality include:

• duration of clinical signs exceeding six hours,
• presence of preoperative cardiac arrhythmias,
• need for partial gastrectomy due to compromised blood supply,
• need for splenectomy.

Postoperative care includes exercise restriction for several weeks to allow surgical incisions to heal. Long-term management typically involves feeding multiple small meals per day instead of a single large meal and ongoing monitoring for recurrence of clinical signs.

After gastropexy, some dogs may still experience gastric dilation without volvulus, usually after consuming an excessively large meal. While gastropexy does not prevent stomach expansion, it significantly reduces the risk of life-threatening volvulus.

As a preventative strategy, many veterinary surgeons recommend prophylactic gastropexy for breeds at increased risk or for dogs with close relatives that have experienced GDV. Prophylactic gastropexy can often be performed at the time of spaying or neutering. Minimally invasive techniques, including laparoscopic-assisted, endoscopically assisted, and grid gastropexy, are available for preventive procedures (Figure 2).