What technique should be used if an orogastric tube cannot be passed for GDV?

In cases of gastric dilatation-volvulus (GDV), where the stomach is distended and potentially twisted, immediate decompression of the stomach is crucial. If an orogastric tube fails to pass through the esophagus into the stomach, the appropriate emergency technique is to use a trocharization method.

Trocharization involves inserting a large bore needle or catheter into the stomach, allowing trapped gas and fluid to escape. Performing this technique on the right side of the abdomen is particularly effective because it aligns with the anatomy of the stomach, which is typically situated in this area. This approach minimizes the risk of damaging surrounding structures and allows for efficient decompression.

Using the ventral approach can pose significant risks and is less targeted for successful decompression. Flipping the patient over or preemptively prepping for surgery without attempting to relieve the pressure may delay necessary care and could exacerbate the condition, leading to further complications. Thus, the right-sided trocharization is the preferred method in such emergencies.