On Monday February 16, 1998, “Mozart”, a male Mastiff, was brought to Berkshire Veterinary Hospital. It was 8:30 PM and his owners knew he was seriously ill. Mozart seemed fine when his owners arrived home late that afternoon but during the last hour his condition had rapidly deteriorated. His abdomen appeared hard and distended, he made repeated attempts to gag and only foam was produced, he quickly became very quiet and lethargic.
Mozart’s emergency exam revealed that he was suffering from gastric torsion or bloat. This diagnosis was further confirmed with abdominal radiographs. His stomach was mal-positioned in such a way that the entrance and exit were sealed, preventing gastric gas from escaping. As the gastric bacteria continued to produce gas his stomach was expanding, much like a balloon. This physical expansion of the stomach makes it difficult for the patient to breathe. The mal-positioned and expanding stomach also compromises the blood flow to the stomach and spleen. Because of lack of blood flow and oxygen, toxins rapidly accumulate in the blood trapped in these organs. Tissue damage rapidly occurs under these conditions. Toxins released from the damaged tissue can cause injury to other organs, including the heart, further complicating the surgical correction and post-operative recovery of these patients.
Gastric torsion is an extremely serious condition. The prognosis for each patient will vary depending on many factors. This is a condition that must be corrected surgically at a time when a patient has a high surgical risk. The amount of internal damage will be one of the factors that dictates the success or failure of each case. Extensive pre and post operative monitoring will be necessary to give each patient the best opportunity for recovery. In some cases, in spite of doing everything possible, the outcome will not be good.
After discussing the necessary surgical procedures and risk factors with Mozart’s family, a decision was made to do all we could to save him.
Mozart was immediately started on intravenous support in an attempt to stabilize his rapidly deteriorating condition. His fluid therapy included not only the routine intravenous fluids but also a colloid solution called Hetastarch. The high molecular weight molecules in this fluid would give us a better chance of maintaining Mozart’s blood pressure throughout his surgery and postoperative period. Several medications were given intravenously to counteract damage done by toxins and oxygen radicals released as the stomach is returned to its normal position.
Mozart was taken to surgery where Drs. Lemieux and King, as well as three veterinary assistants, performed the necessary procedures. Throughout the surgery his blood pressure, heart rate, EKG, and oxygen saturation were closely monitored. Changes were made in the anesthetic levels and intravenous support, to maintain these parameters in as normal a range as possible. Mozart’s stomach was repositioned, while veterinary assistants passed an oral stomach tube into his stomach to further decompress and drain the distended organ. In some cases of gastric torsion, the spleen is severely damaged and must be removed. Mozart’s spleen had become greatly engorged but once it was repositioned it started to decrease in size. The splenic vessels appeared functional and a decision was made to save the spleen. Mozart’s decompressed stomach was surgically attached to his abdominal wall using a procedure called a belt-loop gastropexy. This procedure not only keeps the stomach in place now, it makes it much more difficult for the stomach to “twist” in the future.
Mozart recovered from surgery and was placed on intensive care. He had gotten over the first hurdle and the next twenty-four to forty-eight hours would reveal the extent of his post-operative complications. Throughout the night his EKG, blood pressure, and intravenous support were monitored closely. Pain relief medication was used to minimize the discomfort usually associated with this condition. Mozart wasn’t sure he wanted his IV to run throughout the night but after several “discussions” with the overnight technician, he agreed to leave his drip set intact.
On Tuesday morning Mozart looked great. He was strong enough to be taken outside for a short walk. His EKG was normal. There was no evidence of the ventricular premature contractions often associated with secondary cardiac damage. Blood tests were performed to be sure serum electrolytes were normal. Late in the day he was offered a small amount of bland low fat food. He thought this was a good idea. We started to taper his intravenous support and increased his oral intake.
On Wednesday his progress continued. His surgical incision looked great, his EKG and lab work were normal and plans were made for him to leave the hospital Wednesday evening.
Mozart’s owners continued to administer his medication and monitor his progress at home for the two weeks following his surgery. On March 2nd he returned to BVH for a follow up examination and staple removal. We all felt a great sense of satisfaction to see him saunter in for his exam.