Surgical Decision Needed on Frank: What should we do with his stomach?

Fig. 1: A stomach tube has been placed on Frank.

Signalment and History

Frank  is a 9-year-old castrated male golden retriever who recently presented to our clinic with a history of attempting to vomit for several hours. (Fig. 1) The owner observed that he was uncomfortable and his abdomen was distended.

Physical Examination

Physical examination revealed that Frank was ambulatory but weak and in distress. His mucous membranes were pale pink, capillary refill was > 2 seconds, and he was tachycardic. His abdomen was severely distended and tympanic on percussion.

Imaging and Emergency Treatment

Radiographs revealed a grossly distended and malpositioned stomach consistent with a gastric dilatation volvulus.(Fig. 2) 

Fig. 2: Right lateral abdominal radiograph on Frank showing classic
appearance of a GDV.

Attempts to pass a stomach tube were unsuccessful. (Fig. 1)  A gastrocentesis was performed with a 14 gauge over-the-needle catheter and gas removed. A second attempt at stomach tube passage was then successful and a copious amount of brownish fluid was obtained. Intravenous fluids were administered and Frank was prepared for emergency surgery.

Surgery

Abdominal exploratory revealed a gastric dilatation volvulus. A small amount of blood was present in the peritoneal cavity. The stomach was de-rotated and placed into normal position and the gastric tissues examined. The gastric fundus was inflamed and a portion severely bruised. (Fig. 3-4)

Fig. 3: The gastric body and part of the fundus on Frank.

Fig. 4: The gastric fundus on Frank.

The bruised area was along the greater curvature and extended to the level of the cardia. On palpation of the gastric wall the tissue was moderately thickened. No areas of perforation were seen.

Question

Should this area of stomach be resected? Or should the abnormal area be invaginated? Can this area be left alone and the dog treated postoperatively with supportive care including famotidine and sucralfate?

Select your answer on the poll on the upper right hand column of the blog website. Remember that you must view the blog in “web version” to see the poll. (It does not automatically show up on your mobile phone version.) In a few days I will let you know what I decided to do and how things turned out on Frank.