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180° Volvulus After Omentum Is Removed
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Based upon the relatively recent onset of bloat, our
ability to place a stomach tube, and the relative stable hemodynamics
after fluid therapy, it was decided to attempt surgical correction
laparoscopically. Karma was anesthetized and the stomach tube removed
in order to facilitate tracheal intubation. Our standard laparoscopic-assisted
technique for incisional gastropexy as a preventative procedure
was performed. A Hasson technique was used to place the first trocar
and laparoscopic examination revealed that the stomach had become
distended again. A stomach tube was passed and the stomach deflated.
Omentum covered the stomach, there was a 180° clockwise volvulus,
and modest amounts of hemmorhage from the epigastric vessels. The
stomach wall appeared to be fairly normal and the spleen was only
distended. Using a second trocar and a 10 mm laparoscopic Babcock
forceps, the stomach was repositioned and the antrum attached to
the right abdominal wall just caudal to the last rib and lateral
to the rectus abdominus.
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Gastric Serosa: Minimal Hemorrhage
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Karma recovered rapidly and was discharged from the hospital 48
hours after surgery. Initial plans to discharge Karma at 24 hours
were delayed due to the presence of premature ventricular contractions.
She rapidly returned to her previous activity level of walking 2
miles daily and appeared to be normal when seen for suture removal
at one week. Karma has continued to do well for the past 4 months.
The laparoscopic procedure required only two incisions with neither
being more than 3.5 cm and was performed at least as quickly as
correction by open laparotomy. The technique for laparoscopic-assisted
gastropexy has been published:
Rawlings CA et al: AJVR 2001; 62: 871-875.
Rawlings CA: JAAHA 2002; 38: 15-19.
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Laparoscopic View of
Completed Incisional Gastropexy
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Although this is probably the first dog with laparoscopic treatment
of GDV, the technique has been used as a preventative procedure
in 75 to 100 dogs and it is currently being used for Military Working
Dogs. It would be assumed that dogs presenting with bloat signs
must be carefully screened to be considered candidates for laparoscopic
versus open correction of gastric dilatation-volvulus. Dogs that
are severely depressed and still in shock after initial shock treatment,
those that have eaten foreign bodies needing a gastrotomy, and those
in which intubation is not possible may be inappropriate for laparoscopy.
Even for those patients in which laparoscopy is initially attempted,
the client must be aware that conversion to an open procedure may
be required.
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Karma,
a 12 year old spayed female Standard Poodle was submitted to our
emergency service with signs of bloat. Six weeks previously she
had had a "near-bloat" experience that was not seen by
a veterinarian. Karma had been seen by a local emergency practice
12 hours before admission to our hospital and had been treated by
gastric intubation. She was discharged from the emergency clinic
soon after treatment. At admission to our hospital, she was bloated
and her heartrate was rapid. Karma was intubated and shock dosages
of intravenous fluids were administered.