A twisted stomach, known medically as gastric volvulus, is a condition in which the stomach rotates on itself, cutting off its blood supply and trapping food and gas inside. It is always an emergency. In humans it is rare but potentially fatal if not caught quickly. In dogs, where it is far more common and goes by the name gastric dilatation-volvulus (GDV), it can kill within hours of the first symptoms.
How the Stomach Twists
The stomach is held loosely in place by ligaments that attach it to surrounding organs, the diaphragm, and the abdominal wall. Under certain conditions, the stomach can rotate along one of two axes. In one form, called organoaxial volvulus, the stomach flips along an imaginary line running from the esophagus to the small intestine, so the bottom swings up and over the top. In the other form, mesenteroaxial volvulus, the rotation happens along a shorter axis that splits the stomach between its two curved edges, causing the lower portion to flip upward and forward.1PubMed Central. Spontaneous Acute Mesenteroaxial Gastric Volvulus Diagnosed by Computed Tomography Scan in a Young Man A combination of both can also occur. The organoaxial type is more common and more dangerous because it is more likely to fully obstruct both the inlet and outlet of the stomach, leading to tissue death in roughly 5 to 28 percent of cases.
When the stomach twists even partway, two things happen almost simultaneously. First, the openings at either end of the stomach get pinched shut, so nothing can enter or leave. Gas produced by normal digestion builds up rapidly, inflating the stomach like a balloon. Second, the rotation kinks the blood vessels feeding the stomach wall. Without blood flow, the tissue starts to die. In dogs, this cascade escalates fast: the ballooning stomach presses on the large vein returning blood from the lower body to the heart, blood pools in the organs and hind legs, blood pressure plummets, the heart begins to beat erratically, and the animal can go into shock.2Journal of Small Animal Practice. Canine gastric dilatation‐volvulus In humans a similar sequence unfolds, though typically more slowly because the twist is sometimes partial rather than complete.
Recognizing the Symptoms in People
In humans, gastric volvulus can present as either an acute emergency or a chronic, grumbling problem that comes and goes. The acute form tends to cause sudden, severe upper abdominal pain, an inability to vomit despite feeling the urge, and abdominal bloating. A classic set of signs, sometimes called Borchardt’s triad, combines unproductive retching, pain and distention in the upper belly, and the inability to pass a tube into the stomach through the nose.3PubMed Central. Gastric volvulus, Borchardt’s Triad, and Endoscopy: A Rare Twist In practice, though, that full triad doesn’t always show up, and the symptoms can mimic a heart attack, a gallbladder attack, or a bowel obstruction.
When the stomach twists upward into the chest through a weakened or enlarged opening in the diaphragm, the picture gets even murkier. Patients may report chest fullness, trouble swallowing, or pain after eating, and the condition can be mistaken for heart or lung problems.4PubMed Central. The management of gastric volvulus in elderly patients Delayed diagnosis is one of the biggest dangers, because a stomach deprived of blood can perforate or develop gangrene within hours.
Chronic gastric volvulus, by contrast, tends to cause milder, recurrent episodes of upper abdominal discomfort, nausea, and bloating that resolve on their own when the stomach partially untwists. Some people live with intermittent symptoms for months or years before an acute crisis forces emergency evaluation. A CT scan is the most reliable way to confirm the diagnosis. Radiologists look for the stomach in an abnormal position, signs of obstruction, and any evidence that the blood supply to the wall has been compromised.5PubMed Central. CT of Gastric Volvulus: Interobserver Reliability, Radiologists’ Accuracy, and Imaging Findings
Why It Happens More Often in Certain People
In adults, gastric volvulus is almost always linked to an anatomical weak point. The most common culprit is a large hiatal hernia or diaphragmatic hernia, where the opening in the diaphragm widens enough for part of the stomach to slide up into the chest. Once the stomach is partially in the chest, it has room to rotate in ways it normally wouldn’t. Elderly patients are particularly vulnerable because the ligaments anchoring the stomach weaken with age. Previous abdominal surgery, adhesions, and certain congenital abnormalities can also loosen the stomach’s moorings.
In children and infants, gastric volvulus is rarer still but does occur, usually because of congenital laxity of the ligaments that hold the stomach in place. Some infants outgrow the condition as their ligaments tighten, while others need surgical repair. Adults who develop acute gastric volvulus typically require surgery to untwist the stomach and anchor it so it cannot rotate again, a procedure called gastropexy. When the volvulus is triggered by a diaphragmatic hernia, the hernia is repaired at the same time.
Recognizing GDV in Dogs
If you own a large or giant-breed dog, gastric dilatation-volvulus is probably the version of “twisted stomach” you’ve heard about. GDV is one of the most dramatic surgical emergencies in veterinary medicine and affects thousands of dogs each year. The condition almost always starts with the stomach filling with gas (the dilatation phase) and then rotating (the volvulus phase), though which comes first is still debated.
The signs tend to appear suddenly and worsen quickly. A dog with GDV will usually pace restlessly, drool heavily, and repeatedly try to vomit without producing anything. The abdomen swells visibly, especially on the left side just behind the ribs. If you tap the swollen area, it may sound hollow, like a drum. As the condition progresses, the dog’s gums may turn pale or take on a bluish tint, the heart rate climbs, and the dog may become weak or collapse. From the first signs, you may have as little as one to two hours before shock becomes irreversible, so getting the dog to a veterinary emergency clinic immediately is critical.
Once at the clinic, the veterinary team will try to stabilize the dog with intravenous fluids and decompress the stomach, sometimes by passing a tube through the mouth and sometimes by inserting a needle through the body wall to release trapped gas. Surgery follows to untwist the stomach, assess whether any portion of the stomach wall or spleen has lost blood supply and needs to be removed, and then permanently tack the stomach to the body wall (gastropexy) to prevent recurrence.
Which Dogs Are Most at Risk
GDV overwhelmingly affects large and giant breeds with deep, narrow chests. Great Danes face the highest lifetime risk, followed by breeds like Saint Bernards, Weimaraners, Irish Setters, German Shepherds, and Standard Poodles. A genome-wide study found that lifetime risk across susceptible breeds ranges from roughly 4 percent to nearly 37 percent, and identified specific genetic variants in genes involved in stomach muscle tone and motility that may explain why some individual dogs are more vulnerable than others.6PubMed Central. Identification of Genetic Susceptibility Factors Associated with Canine Gastric Dilatation-Volvulus Body shape, in particular a deep chest relative to width, is a well-documented anatomical risk factor.7PubMed. Inherited and predisposing factors in the development of gastric dilatation volvulus in dogs
Beyond genetics and body type, several environmental and behavioral factors have been linked to GDV. Eating one large meal a day rather than two or three smaller ones, eating rapidly, exercising vigorously right after eating, and having a fearful or anxious temperament have all been associated with higher risk. Older dogs are more prone than younger ones, and having a first-degree relative who suffered GDV increases the odds. Some of these risk factors are actionable: feeding smaller, more frequent meals, using a slow-feeder bowl, and avoiding intense exercise for at least an hour after eating are commonly recommended steps for owners of at-risk breeds.
Prophylactic Gastropexy
Because GDV is so dangerous and treatment so expensive, many veterinarians now recommend a preventive gastropexy for high-risk breeds. This procedure surgically attaches the stomach to the abdominal wall before GDV ever occurs, and it is often done at the time of spay or neuter to avoid an additional anesthesia event. A large study of over 760 dogs that underwent prophylactic gastropexy found that complications directly related to the procedure were very rare, occurring in only about 0.4 percent of cases, and none of the dogs with long-term follow-up went on to develop GDV.8PubMed Central. Outcomes and complications of prophylactic incisional gastropexy in 766 dogs (2009-2019)
From a cost perspective, an analysis found that prophylactic gastropexy reduced the risk of death from GDV anywhere from about two-fold to nearly thirty-fold depending on the breed, with the greatest benefit in Great Danes.9PubMed. Benefits of prophylactic gastropexy for dogs at risk of gastric dilatation-volvulus The procedure was considered cost-effective whenever the dog’s estimated lifetime risk of GDV exceeded roughly 34 percent. Given that Great Danes can approach or exceed that threshold, the math strongly favors prevention for the highest-risk breeds. Minimally invasive techniques, including laparoscopic-assisted and radiologic-assisted approaches, have also proven safe and may mean a shorter recovery for the dog.10PubMed. Efficacy of Two Radiologic-Assisted Prophylactic Gastropexy Techniques
What Happens After Emergency Surgery
Surviving the surgery is a major hurdle, but recovery brings its own challenges. One of the most concerning postoperative complications in dogs is cardiac arrhythmia, which can develop in the hours and days following surgery. The heart may beat irregularly because of toxins released when blood flow returns to damaged tissue, electrolyte imbalances, or direct effects of shock on the heart muscle. Dogs are typically monitored on continuous ECG for 48 to 72 hours after GDV surgery. The prognostic significance of these arrhythmias has been debated. Some studies found that dogs who developed postoperative ventricular arrhythmias had higher mortality, while at least one concluded that arrhythmia alone wasn’t a reliable predictor of outcome.11Veterinary Evidence. Does occurrence of ventricular arrhythmia reduce the survival rate in dogs with gastric dilatation volvulus (GDV)?
Blood lactate levels measured at admission and after initial fluid therapy are commonly used to estimate how badly the body has been affected. Lower lactate generally predicts better survival, and a lactate level that drops after fluids is a reassuring sign. A high lactate or one that stays elevated is more worrying, though research has found significant overlap in lactate values between dogs that survived and those that did not, meaning the test works better as a positive signal than a negative one.12PubMed Central. Gastric dilatation volvulus in dogs: utility of lactate as a predictor of survival If part of the stomach wall or the spleen had to be removed during surgery due to tissue death, the recovery period is longer and the risk of complications higher.
For dogs that survive and have had a gastropexy performed at the same time, the long-term outlook is generally good. The stomach can still dilate with gas, but the surgical attachment to the body wall prevents the life-threatening rotation. Owners are usually advised to continue the same preventive feeding and exercise habits recommended for at-risk breeds.
The Financial Side of GDV
An underappreciated factor in GDV outcomes is the cost of treatment. Emergency GDV surgery, including stabilization, anesthesia, the procedure itself, and several days of hospitalization and monitoring, can easily run into the thousands. A study at an Australian referral hospital found that uninsured dogs were five times more likely to be euthanized before surgery than insured dogs, with nearly two-thirds of uninsured dogs euthanized in the emergency room compared to none of the insured dogs in the study.13PubMed. Pet health insurance reduces the likelihood of pre-surgical euthanasia of dogs with gastric dilatation-volvulus in the emergency room of an Australian referral hospital This doesn’t mean insurance is necessary for every dog, but for owners of high-risk breeds, the combination of pet insurance and prophylactic gastropexy represents a practical strategy that meaningfully improves the odds.
Twisted Stomachs in Other Animals
Dogs get most of the attention, but stomach torsion occurs across the animal kingdom. In cattle, the abomasum (the “true stomach” of a ruminant) can displace to the left or right side of the abdomen or twist on itself entirely. Right-sided displacement with volvulus tends to be more severe and harder to diagnose than left-sided displacement. A study of nearly 2,000 dairy cows found that a definitive diagnosis based on clinical signs alone was possible in only about a quarter of right-displaced or volvulus cases, compared to three-quarters of left-displaced cases, with ultrasound and surgical exploration often needed to confirm the twist.14PubMed Central. Left and right displaced abomasum and abomasal volvulus: comparison of clinical, laboratory and ultrasonographic findings in 1982 dairy cows In cattle, the condition is closely tied to the metabolic stress of early lactation and high-concentrate diets.
Ferrets, guinea pigs, and some exotic species can also experience gastric torsion, though reported cases are sporadic and the veterinary literature is thinner. The common thread across all species is the same: once the stomach twists far enough to compromise its blood supply, time is short and surgical intervention is the only reliable fix.
Chronic Versus Acute Gastric Volvulus in Humans
One aspect that surprises many people is that a stomach twist in humans doesn’t always arrive as a screaming emergency. Chronic gastric volvulus, where the stomach repeatedly rotates partway and then untwists, can produce vague symptoms that are dismissed as acid reflux, indigestion, or anxiety for years. Patients often describe a feeling of fullness after eating small amounts, intermittent nausea, and an uncomfortable sensation of pressure in the chest or upper abdomen. Some develop anemia from slow bleeding at the site where the twisted tissue rubs against itself.
The chronic form is most frequently associated with a large paraesophageal hernia, in which part of the stomach pushes up alongside the esophagus through the diaphragm. Because the symptoms are nonspecific, patients may see multiple specialists and undergo rounds of testing before a CT or upper GI series finally catches the stomach in an abnormal position. Management of chronic cases is less straightforward than the acute scenario. Surgery to repair the hernia and anchor the stomach is the definitive treatment, but in elderly or frail patients with significant surgical risk, some clinicians opt for careful monitoring and symptom management instead.15PubMed Central. Chronic Intrathoracic Gastric Volvulus Management: Could Less Be More? The decision often comes down to weighing the risk of a major operation against the risk of an unpredictable acute twist occurring in a patient who might not tolerate emergency surgery.
For anyone who has been diagnosed with a large hiatal or paraesophageal hernia, being aware that gastric volvulus is a possible complication is worthwhile. Knowing the symptoms of an acute twist, particularly the sudden onset of severe pain combined with an inability to vomit, can make the difference between getting to an emergency room in time and arriving too late.