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Gastric dilatation and volvulus

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Abstract

Gastric dilatation and volvulus (GDV) is an acute life-threatening abnormal accumulation of gastric gas (dilatation), which may be complicated by rotation of the stomach (volvulus) about its mesenteric axis. This chapter looks at pathophysiology, diagnosis and management, techniques and treatment. Tube gastropexy; Belt loop gastropexy; Incisional gastropexy.

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Figures

Image of 6.1
6.1 Ventral view of 180-degree rotation of the stomach. (a) Pylorus moves ventrally from right to left. (b) Pylorus and body of stomach move clockwise. (c) Pylorus lies to left of stomach. (d) Pylorus moves more dorsally. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 6.5
6.5 Right lateral radiograph showing gastric volvulus. (© John Williams)
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6.7 ECG traces. (a) Ventricular premature contractions (VPCs). Note that every fourth beat is a VPC (arrowed). (b) Ventricular tachycardia. Note wide ‘bizarre’ QRS complexes.
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6.8 (a) A 7.5 cm adhesive bandage roll with plastic core. (b) The roll placed ‘end-on’ orally with similar tape wrapped around the dog’s muzzle to facilitate passage of a stomach tube. (© John Williams)
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6.9 Gastric lavage. (a) Recumbent dog undergoing gastric lavage. (b) ‘Typical’ contents from gastric lavage. (© John Williams)
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6.10 Dog’s clipped right flank, prepared aseptically and with a 16 G intravenous needle inserted. (© John Williams)
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6.12 Omentum ‘covering’ a clockwise-rotated stomach. The stomach serosa is inflamed and potentially ischaemic. (© John Williams)
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6.13 Pylorus being lifted gently from left (L) to right. (© John Williams)
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6.14 Erythematous (inflamed) serosa on the greater curvature of stomach following GDV. (© John Williams)
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6.15 Invagination. (a) Cross-sectional view of the greater curvature to show invagination (the stippled area is the non-viable area). (b) Invagination in process, using a continuous suture pattern. (c) Invagination completed. (Photographs © John Williams). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of Foley catheter being drawn into the abdominal cavity.
Foley catheter being drawn into the abdominal cavity. Foley catheter being drawn into the abdominal cavity.
Image of Foley catheter being introduced into the stomach (pyloric antrum) after pre-placing a purse-string suture.
Foley catheter being introduced into the stomach (pyloric antrum) after pre-placing a purse-string suture. Foley catheter being introduced into the stomach (pyloric antrum) after pre-placing a purse-string suture.
Image of Omentum wrapped around the catheter. (© John Williams)
Omentum wrapped around the catheter. (© John Williams) Omentum wrapped around the catheter. (© John Williams)
Image of Relative positions of the catheter, stomach and body wall.
Relative positions of the catheter, stomach and body wall. Relative positions of the catheter, stomach and body wall.
Image of Roman Sandal suture. (© John Williams)
Roman Sandal suture. (© John Williams) Roman Sandal suture. (© John Williams)
Image of A tongue of seromuscular tissue is created from the stomach wall over the pyloric antrum, incorporating two short gastric arteries.
A tongue of seromuscular tissue is created from the stomach wall over the pyloric antrum, incorporating two short gastric arteries. A tongue of seromuscular tissue is created from the stomach wall over the pyloric antrum, incorporating two short gastric arteries.
Image of Two parallel incisions are made in the transversus muscle of the abdominal wall, caudal to the costal arch; a tunnel, wider than the flap, is created by blunt dissection with artery forceps.
Two parallel incisions are made in the transversus muscle of the abdominal wall, caudal to the costal arch; a tunnel, wider than the flap, is created by blunt dissection with artery forceps. Two parallel incisions are made in the transversus muscle of the abdominal wall, caudal to the costal arch; a tunnel, wider than the flap, is created by blunt dissection with artery forceps.
Image of The seromuscular pedicle is drawn gently through the tunnel with Babcock forceps.
The seromuscular pedicle is drawn gently through the tunnel with Babcock forceps. The seromuscular pedicle is drawn gently through the tunnel with Babcock forceps.
Image of The flap is sutured into its original bed in the gastric wall.
The flap is sutured into its original bed in the gastric wall. The flap is sutured into its original bed in the gastric wall.
Image of Incision in the right lateral body wall through the peritoneum and transversus abdominis muscle.
Incision in the right lateral body wall through the peritoneum and transversus abdominis muscle. Incision in the right lateral body wall through the peritoneum and transversus abdominis muscle.
Image of Partial thickness incision in the pyloric antrum.
Partial thickness incision in the pyloric antrum. Partial thickness incision in the pyloric antrum.
Image of Suturing the gastric incision edges to the edges of the body wall incision with a simple continuous suture pattern (the caudal edges are sutured in the same manner).
Suturing the gastric incision edges to the edges of the body wall incision with a simple continuous suture pattern (the caudal edges are sutured in the same manner). Suturing the gastric incision edges to the edges of the body wall incision with a simple continuous suture pattern (the caudal edges are sutured in the same manner).

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