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Gastric necrosis has been reported in 9.3–40.6% of dogs with GDV [9, 10,12–14, 22, 28,50–52]. In dogs with an area of suspected devitalized or necrotic gastric wall, surgical treatment of this, ideally with a partial gastrectomy, is mandatory. Several studies have shown that dogs with gastric necrosis or those that require gastric resection have a significantly increased mortality, with up to 62.5% of dogs not surviving (including those euthanized due to the severity of necrosis) [10, 13, 23, 29, 51, 53]. Failure to perform a partial gastrectomy in dogs with gastric necrosis will result in gastric perforation, peritonitis and SIRS and has been associated with a mortality rate of 100% [11]. Although resection and reconstruction of devitalization and necrosis of the gastric cardia and distal esophagus is possible, it is technically demanding and the prognosis for these animals is grave [9, 13]. Although rare, gastric necrosis can lead to perforation and contamination of the peritoneal cavity prior to surgical exploration. In these dogs, gastric resection and gastropexy as well as treatment for peritonitis (see Chapter 11) are required.