Case report: gastric dilatation volvulus and bile peritonitis in a 5-month old canine

Abstract

Introduction.  Gastric volvulus dilatation (GDV) in dogs is an acute, life-threatening and emergent syndrome, while biliary peritonitis is a rare condition whose prognosis is usually dependent on the underlying cause. Objective.  To describe the diagnostic and therapeutic protocol applied in the case of a canine patient with anorexia and acute abdominal dilatation. Methodology.  By radiography, the patient was diagnosed with probable GDV and initial stabilization was performed with fluid therapy, oxygen therapy, gastric decompression by percutaneous trocarization and orogastric tubing. The patient remained stable after this initial management, but after 72 hours, he presented free fluid in the hepato-diaphragmatic region, attributable to biliary peritonitis. During surgical resolution, necrotizing cholecystitis and congestion in the square lobe were evidenced, so cholecystectomy and partial hepatic lobectomy were performed using harmonic scalpel (ETICON GEN 11). A closed active drain was placed and the patient remained in hospital for three days with antibiotic treatment, analgesia and gastric protectors, for his subsequent discharge home. Results.  Ten days after initiating home management with antibiotic therapy, analgesia and gastric protectors, the patient presented adequate cicatrization and was discharged home. The adequate pre-surgical stabilization together with the post-surgical management (by means of wound antisepsis and pharmacological therapy) were fundamental for the resolution of the clinical case in spite of the complication that biliary peritonitis could have caused. Conclusion. In GVD patients it is essential to evaluate blood pressure and lactatemia as relevant factors to improve the post-surgical prognosis. In addition, it is essential to consider alterations in other organs and evaluate them to rule them out (such as biliary peritonitis in this case).