Gastric Dilatation-Volvulus Syndrome: Outcome and Factors Associated with Perioperative Mortality

Abstract

Gastric dilatation-volvulus (GDV) or gastric dilatation (GD), were diagnosed in 173 dogs during the period from 1997 to 2001. Risk factors possibly associated with higher mortality in cases of GDV were evaluated. Variables suitable for quantitative evaluation were examined by the Student's t-test with regard to the risk of death. We characterised groups of dogs with potential risk factors (age, body weight, time lapsed from the last feeding until presentation, time lapsed from the onset of clinical signs until presentation, time lapsed from the last feeding until the onset of clinical signs), and compared the groups with regard to the risk of death, using the χ 2 -test. There were no differences between the dying and surviving patients as to their age, body weight and time lapsed from the last feeding until the onset of clinical signs. The time lapsed from the onset of clinical signs until presentation at the clinic was a significant factor associated with a lower survival rate. Mortality in dogs with GDV was 26.3% (36/137). Significantly higher mortality (p < 0.01) was found in dogs with gastric necrosis. Gastric necrosis in dogs with GDV is responsible for a 6.5 times higher risk of death compared to patients without gastric necrosis. There was also higher mortality in dogs after splenectomy (p < 0.05). Results of our study suggest that the most important prognostic factor is a timely treatment following the onset of clinical signs of GDV. Dog, retrospective study, gastric necrosis, splenectomy, risk factors, feedingGastric dilatation-volvulus (GDV) is a very serious, life-threatening syndrome typically affecting large and giant breeds of dogs. For example, in the United States of America this syndrome affects about 60 000 dogs a year (Burrows and Ignaszewski 1990). The risk of this syndrome in some dog breeds is very high. In the Great Dane it amounts to more than 40% (Glickman et al. 2000). Despite its recognition more than 90 years ago (Cadeac 1906) and considerable advances in diagnosis and treatment, mortality associated with GDV still remains high. Various studies report mortality varying from 10 to 60% (Betts et al. 1974;Muir 1982;Walshaw and Johnson 1976;Matthiesen 1983;Frankquist and Obel 1979; Winfgield et al. 1975;Glickman et al. 1994;Brockman et al. 1995;Brourman 1996;Van Sluijs 1991;Glickman et al. 1998;Eggertsdóttir and Moe 1995;Nagel and Neumann 1992). It is, however, difficult to compare individual results because of differences in the definition of mortality and different therapeutic procedures within individual studies.On the basis of our current knowledge, therapy of the syndrome consists of three important parts:1) immediate and aggressive patient stabilisation including gastric decompression and treatment of shock; 2) surgical correction of volvulus including gastropexy to prevent recurrence; and 3) post-operative monitoring and intensive care (Matthiesen 1983;Aronson et al.

Evaluation of lidocaine treatment on frequency of cardiac arrhythmias, acute kidney injury, and hospitalization time in dogs with gastric dilatation volvulus

“…It might also decrease the mortality rate, as there was a trend for decreased mortality in the study group. The average mortality rate in the present control group is similar to an average mortality rate of 20% (SD 6%) recorded in 6 previous studies of GDV in dogs, published over the last 5 y, 2,3,[26][27][28][29] which is compared to the study group (10.8%). Nevertheless, because the present mortality rate differences between groups did not reach statistical significance (P = 0.056), this conclusion should be made with caution, and further larger, prospective studies of lidocaine therapy in GDV are warranted to examine this effect of lidocaine.…”

“…This potentially results from one or several factors, including sustained poor perfusion, exposure to endotoxin, thromboembolism, and IRI . The overall occurrence of AKI was significantly less common in the study group, potentially due to beneficial and preventive effects of lidocaine through its vasodilatory and vascular protective properties . It has been shown in microvascular surgery in rabbits, both in vivo and in vitro, that lidocaine acts as a spasmolytic agent and its topical application has led to improved carotid artery blood flow .…”

“…4,11,14 The overall occurrence of AKI was significantly less common in the study group, potentially due to beneficial and preventive effects of lidocaine through its vasodilatory and vascular protective properties. [16][17][18][19]26 It has been shown in microvascular surgery in rabbits, both in vivo and in vitro, that lidocaine acts as a spasmolytic agent and its topical application has led to improved carotid artery blood flow. 26 In a similar manner, lidocaine can potentially improve blood flow to preischemic tissues, including the kidneys, which are highly susceptible to ischemic injury.…”

“…[16][17][18][19]26 It has been shown in microvascular surgery in rabbits, both in vivo and in vitro, that lidocaine acts as a spasmolytic agent and its topical application has led to improved carotid artery blood flow. 26 In a similar manner, lidocaine can potentially improve blood flow to preischemic tissues, including the kidneys, which are highly susceptible to ischemic injury. 10,11,18 Unfortunately, information regarding hypotensive events during anesthesia, which might have predisposed decreased perfusion and AKI, were not available in the control group, thus their proportion could not be compared between groups to further support the above explanation.…”

Myoglobin as a prognostic indicator for outcome in dogs with gastric dilatation‐volvulus

“…[1][2][3][4][5][6] Epidemiologic studies have implicated certain risk factors that may predispose dogs to GDV (ie, breed, increased thoracic depth-to-width ratio, diet, climatic conditions, evidence of inflammatory bowel disease, previous splenic torsion, or splenectomy) and several factors that significantly increase mortality (peritonitis, gastric necrosis, partial gastrectomy and splenectomy, disseminated intravascular coagulation, systemic inflammatory response syndrome, sepsis, reperfusion injury, microinfarction, autonomic dysbalance, acid-base and electrolyte disturbances, increased myocardial depressant factor, tachycardia, and hypotension). [2][3][4][7][8][9][10][11][12][13][14][15][16][17][18][19][20] GDV is characterized by gastric malposition, rapid accumulation of air and gas in the stomach, increased intragastric pressure, secondary portal hypertension, gastrointestinal ischemia, reduced venous return, decreased cardiac output, decreased coronary blood flow, myocardial ischemia, subendothelial myocardial necrosis, arrhythmias, hypotension, and cardiogenic, and hypovolemic shock. 2,3,5,13,[21][22][23] Clinical assessment of the severity of myocardial damage can be determined in some cases using physical examination, heart rate, ECG, radiographs, and echocardiography.…”