Stomach torsion dilatation syndrome
- Stomach dilation is a serious and potentially fatal disease if prompt treatment is not implemented.
- Emergency decompression of the stomach and fixation of the stomach to the abdominal wall is necessary.
- The survival rate after surgery is 90% if the stomach is not in the process of necrosis. If a portion of the stomach is devitalized, the survival rate is only 50% despite medical and surgical treatment.
- Preventive surgery under laparoscopy is possible in dogs whose breed is predisposed to this condition.
The stomach is located in the cranial part of the abdomen and is the first part of the gastrointestinal tract of the abdomen. Stomach torsional dilation syndrome (STDS) is a condition that begins with the distension of the stomach by food, liquids such as drinking water, or air due to panting breathing. The stomach then turns clockwise when dilated. The oesophagal entry route and the exit route to the intestine are blocked and food, liquids and air cannot escape. Unproductive vomiting efforts follow.
Because of the twisting and displacement of the stomach, the blood supply may be blocked and all or part of the stomach wall may die. The longer the torsion time before emergency treatment, the greater the risk of gastric necrosis.
Another consequence is the occlusion of the vena cava which brings back blood from the whole back of the body and causes a shock. Shock is a situation in which inadequate organ perfusion is fatal if left untreated. Clinical signs are pale mucous membranes, tachycardia, weak pulse. SDTE animals are generally very weak and require immediate aggressive treatment.
Less frequently, the nerves in the stomach are damaged by ETS and cause paralysis of the muscles in the stomach wall. Chronic dilatation follows which does not respond to any treatment.
Treatment of the SDTE
Venous lines are placed and fluids and medications are administered in an attempt to counter the state of shock. Decompression procedures are then implemented. An anaesthetic is administered and a tube is passed into the stomach via the oesophagus to empty the stomach to the maximum. If the tube cannot be passed into the stomach because of the twisting of the oesophagus, a large needle is placed in the stomach through the abdominal wall to initiate decompression.
When his condition allows it, the animal is operated on. Signs of necrosis are being looked for on the organs. The stomach is repositioned and can be anchored on the right side of the abdomen to prevent a recurrence. Sometimes, an area of necrosis is detected on the stomach and requires removal. When too much stomach is affected, euthanasia may be recommended. If the stomach could not be emptied by the oesophagal tube, it is then opened to be emptied.
Sometimes the spleen is also twisted and blood clots have developed in its vessels. The removal of the spleen (splenectomy) is then necessary. Dogs can live normally without a spleen. The animal may also have heart rhythm disorders. They are present in about 40% of cases if a spleen problem requires its removal. These disorders can be lethal and require special treatment.
Post-operative and convalescent care
- After surgery, intensive care is needed to hope for a successful outcome. Infusions and antibiotics are administered for at least 24 hours. Blood pressure is monitored regularly The ECG is monitored during and after surgery to detect arrhythmias early and treat them if necessary as they can be, although infrequently, fatal.
- Signs of disseminated intravascular coagulation (DIC) are sought. In this case, the clotting mechanism gets out of control and clots from anywhere, a multi-organ failure then appears with a clotting defect. DIC is often fatal, hence the need for early treatment
- In general, about 90% of animals with ETS survive if treated promptly. 10 to 14 days later, most patients are doing very well. If a portion of the stomach is dead and must be removed, the survival rate is only about 50%.
- A restricted activity of 3 to 4 weeks must be put in place so that the stomach sutures do not give way. Walks are only hygienic and on a leash, jumping and running games are prohibited.
- After the animal has presented an SDTE, the feed ration must be divided into 2 to 3 meals and limited exercise 2 hours after the meal to avoid bloating (torsion can no longer occur because of the operation). Chronic dilation is a possible problem following such an episode.
- As with any surgery, complications can occur. Although rare, death during anaesthesia may occur. The use of modern anaesthetic protocols and monitoring equipment (ECG, pulse oximetry) minimises the risk.
- Infection is an infrequent complication since strict sterility techniques are used during the procedure and antibiotics are administered.
- Cardiac arrhythmia.
- DIC results in multi-organ failure, bleeding disorders and often death.
- Release of the stomach attachment on the wall (gastropexy) in less than 5% of cases.
- Chronic dilation. Infrequent, it is due to a functional defect of the stomach muscle. Medications can be administered, but efficacy is limited to 50% of cases. The clinical appearance is similar to the SDTE, but the stomach does not twist.
- Due to the wide variability in the condition of animals with ETS, it is difficult to predict whether your animal will develop postoperative complications. In general, animals with gastric necrosis do much worse than those with minimal trauma.
- In the case of rapid treatment, about 90% of treated and operated dogs survive.
- If at the time of surgery a portion of the stomach is dead, the chances of survival are 50%.
Prophylactic surgery (preventive)
- Preventive surgery can be performed to minimize the risk of SDTE in at-risk individuals such as Great Danes, German Shepherds, Irish Wolfhounds, Dobermans and other large thorax dogs. Great Danes are the most at risk and a study shows that 25% of them dilate during their lifetime.
- This surgery can be done from the age of 6 months. It presents few risks, anaesthetic time and hospitalisation are shorter, and the cost is less than with SDTE.
- However, it must be kept in mind that the best prevention of the SDTE remains the use of a good quality diet, the splitting of meals and the prohibition of exercise after meals and especially after the evening meal.