In the Literature
Mur PE, Appleby R, Phillips KL, et al. Radiographic findings in dogs with 360 degrees gastric dilatation and volvulus. Vet Radiol Ultrasound. 2025;66(1):e13445. doi:10.1111/vru.13445
The Research …
Gastric dilatation-volvulus (GDV; ie, bloat) is an emergent cause of acute abdomen in dogs with high risk for morbidity and mortality.1 Prompt diagnosis and stabilization are key for a successful outcome.1,2 With GDV, the stomach usually rotates ≈180 degrees (180-GDV), causing leftward craniodorsal malpositioning of the pylorus (Figure 1).3 On right lateral radiographs, the stomach compartmentalizes, and the pylorus abnormally fills with gas, creating a pathognomonic appearance. If the stomach rotates 360 degrees (360-GDV), the pylorus returns to a more normal position, where it fills with fluid and becomes less visible (Figure 2), appearing similar to gastric dilatation (GD) without volvulus (Figure 3).3,4
FIGURE 1 Right lateral radiograph of a dog with 180-GDV. Severe gastric dilatation with a craniodorsally displaced pylorus (arrows) is creating compartmentalization of the stomach. Diffuse small intestinal dilation (carets) and splenomegaly (pound sign) can also be seen.
The primary goal of this multi-institutional retrospective study was to describe and compare plain abdominal radiographic findings of dogs with confirmed 360-GDV (n = 16) to dogs with 180-GDV (n = 37) and dogs with GD (n = 28).
Dogs in all 3 groups had similar signalment and presentation; however, dogs with 360-GDV were more likely to be male and have more severe tachycardia (mean, 184 bpm; standard deviation ± 33). Plain radiography was suggested as insensitive (mean, 47.9%) for differentiating 360-GDV from presumptive GD, primarily due to lack of clear pyloric malpositioning on the lateral projection and other overlapping imaging findings. Esophageal dilation, more severe gastric dilatation, decreased serosal detail, and less severe small intestinal dilation were more strongly associated with 360-GDV compared with GD. Although radiography was specific (mean, 88.7%) for 360-GDV, lower prevalence of disease reduces the expected positive predictive value of radiography but increase the negative predictive value. This study confirmed that radiography was sensitive (87.4%) and specific (89.4%) for diagnosing 180-GDV.
… The Takeaways
Key pearls to put into practice:
Diagnosing 360-GDV in patients presented with acute abdomen is challenging, as the radiographic appearance is more similar to GD than 180-GDV. Severe gastric dilatation, esophageal dilatation, severe tachycardia (>150 bpm), and male sex may increase clinical suspicion for 360-GDV. Radiographs may also reveal decreased serosal detail but lack significant small intestinal dilation.
Right lateral projection is typically the only view needed to diagnose 180-GDV, but dorsoventral and left lateral projections may also augment diagnosis. Although not a significant finding in this study, dogs with 360-GDV had a more midline location of the pylorus compared with dogs with GD. Strong clinical suspicion for 180-GDV or 360-GDV indicates cautious use of ventrodorsal positioning for radiography because of potential caudal vena caval compression by abnormally positioned abdominal viscera, which further worsens hypovolemic shock via poor venous return.
GDV is a dynamic disease, and failure to stabilize patients via fluid therapy, gastric decompression, and surgery increases morbidity and mortality. Even if initial radiography is inconclusive, patients with suspected GDV of any type should be closely monitored for signs of clinical decline, and radiographic evaluation should be repeated after 1 to 2 hours. Postoperative recovery from routine gastropexy in a patient with GD is preferable to a patient declining or dying from undiagnosed GDV.
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